Provider Demographics
NPI:1760966543
Name:MCCULLAR, NATALIE A (APRN)
Entity Type:Individual
Prefix:
First Name:NATALIE
Middle Name:A
Last Name:MCCULLAR
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:NATALIE
Other - Middle Name:A
Other - Last Name:JOOS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 E LIBERTY ST STE 800
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40202-1428
Mailing Address - Country:US
Mailing Address - Phone:502-540-3338
Mailing Address - Fax:502-540-3393
Practice Address - Street 1:874 W LANIER AVENUE
Practice Address - Street 2:STE 220
Practice Address - City:FAYETTEVILLE
Practice Address - State:GA
Practice Address - Zip Code:30214
Practice Address - Country:US
Practice Address - Phone:678-833-1444
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-09-18
Last Update Date:2022-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012684363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner