Provider Demographics
NPI:1598795304
Name:PULCHER, DAVID WAYNE (PHD)
Entity Type:Individual
Prefix:DR
First Name:DAVID
Middle Name:WAYNE
Last Name:PULCHER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8575 W 110TH ST STE 200
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66210-2774
Mailing Address - Country:US
Mailing Address - Phone:913-345-0033
Mailing Address - Fax:913-345-0177
Practice Address - Street 1:8575 W 110TH ST STE 200
Practice Address - Street 2:
Practice Address - City:OVERLAND PARK
Practice Address - State:KS
Practice Address - Zip Code:66210-2774
Practice Address - Country:US
Practice Address - Phone:913-345-0033
Practice Address - Fax:913-345-0177
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-04
Last Update Date:2021-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSKS LP #0746103T00000X
MOPY01331103T00000X
MOMO#PY01331103T00000X
KSKS#746103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS100239720AMedicaid
KS100239720AMedicaid