Provider Demographics
NPI:1134158207
Name:KULLEN, RICHARD C III (PA-C)
Entity type:Individual
Prefix:MR
First Name:RICHARD
Middle Name:C
Last Name:KULLEN
Suffix:III
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2201 45TH ST
Mailing Address - Street 2:EMERGENCY ROOM
Mailing Address - City:WEST PALM BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33407-2047
Mailing Address - Country:US
Mailing Address - Phone:561-863-3901
Mailing Address - Fax:
Practice Address - Street 1:2201 45TH ST
Practice Address - Street 2:EMERGENCY ROOM
Practice Address - City:WEST PALM BEACH
Practice Address - State:FL
Practice Address - Zip Code:33407-2047
Practice Address - Country:US
Practice Address - Phone:561-863-3901
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-01
Last Update Date:2007-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPA9102335363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
P96897Medicare UPIN
FLE9006XMedicare ID - Type Unspecified