Provider Demographics
NPI:1871643270
Name:PULLIUM, CHERYL LYNN (DNP APRN RN ACNS-BC)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LYNN
Last Name:PULLIUM
Suffix:
Gender:F
Credentials:DNP APRN RN ACNS-BC
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Mailing Address - Street 1:1601 RIO GRANDE ST
Mailing Address - Street 2:SUITE 340
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78701-1137
Mailing Address - Country:US
Mailing Address - Phone:512-324-8960
Mailing Address - Fax:512-324-8962
Practice Address - Street 1:2370 W BRIARGATE DR
Practice Address - Street 2:
Practice Address - City:BRYAN
Practice Address - State:TX
Practice Address - Zip Code:77802-2117
Practice Address - Country:US
Practice Address - Phone:512-629-5620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2022-10-12
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TXAP115558364SA2200X
TX660646364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX283268502Medicaid
TX283268501Medicaid
TX847N86OtherBCBS
TX8L23235Medicare UPIN
TXTXB132766Medicare PIN