Provider Demographics
NPI:1558367045
Name:PULVER, KURT HAROLD (PA)
Entity Type:Individual
Prefix:MR
First Name:KURT
Middle Name:HAROLD
Last Name:PULVER
Suffix:
Gender:M
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1724 HAMILL RD STE 204
Mailing Address - Street 2:
Mailing Address - City:HIXSON
Mailing Address - State:TN
Mailing Address - Zip Code:37343-5098
Mailing Address - Country:US
Mailing Address - Phone:423-877-4705
Mailing Address - Fax:
Practice Address - Street 1:1724 HAMILL RD STE 204
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5098
Practice Address - Country:US
Practice Address - Phone:423-877-4705
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-21
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN61363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
10397I5240Medicare PIN
AK163960Medicare PIN