Provider Demographics
NPI:1740576222
Name:PULLIAM, PATRICIA D (APRN)
Entity Type:Individual
Prefix:
First Name:PATRICIA
Middle Name:D
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:PATRICIA
Other - Middle Name:D
Other - Last Name:EHRLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 936
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40743-0936
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:606-330-7825
Practice Address - Street 1:875 PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:BARDSTOWN
Practice Address - State:KY
Practice Address - Zip Code:40004-2529
Practice Address - Country:US
Practice Address - Phone:502-348-5685
Practice Address - Fax:502-348-1771
Is Sole Proprietor?:No
Enumeration Date:2011-06-23
Last Update Date:2019-12-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006971363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100170850Medicaid