Provider Demographics
NPI:1609956150
Name:BULLEY, KENDA DEE (ARNP)
Entity Type:Individual
Prefix:
First Name:KENDA
Middle Name:DEE
Last Name:BULLEY
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 25608
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84125-0608
Mailing Address - Country:US
Mailing Address - Phone:206-320-4476
Mailing Address - Fax:206-586-7043
Practice Address - Street 1:600 BROADWAY
Practice Address - Street 2:SUITE 340
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98122-5371
Practice Address - Country:US
Practice Address - Phone:206-386-6171
Practice Address - Fax:206-386-6148
Is Sole Proprietor?:No
Enumeration Date:2006-10-17
Last Update Date:2015-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAAP60033486363L00000X, 363LA2200X, 363LC0200X, 363LF0000X, 363LP2300X
WARN00103331364SM0705X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care
No364SM0705XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistMedical-Surgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA9630807Medicaid
VA124770OtherL & I