Provider Demographics
NPI:1437417060
Name:COULTER, KIRSTEN BAUM (PNP)
Entity Type:Individual
Prefix:MRS
First Name:KIRSTEN
Middle Name:BAUM
Last Name:COULTER
Suffix:
Gender:F
Credentials:PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:43 DEE HENDERSON DR
Mailing Address - Street 2:
Mailing Address - City:RICHMOND HILL
Mailing Address - State:GA
Mailing Address - Zip Code:31324-7603
Mailing Address - Country:US
Mailing Address - Phone:850-819-9112
Mailing Address - Fax:
Practice Address - Street 1:BULLOCH PEDIATRICS GROUP, LLC
Practice Address - Street 2:1044 BERMUDA RUN ROAD
Practice Address - City:STATESBORO
Practice Address - State:GA
Practice Address - Zip Code:30458
Practice Address - Country:US
Practice Address - Phone:912-871-4847
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-02
Last Update Date:2019-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA195756363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics