Provider Demographics
NPI:1255883500
Name:KULL, KELLY A
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:A
Last Name:KULL
Suffix:
Gender:F
Credentials:
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 1510
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47706-1510
Mailing Address - Country:US
Mailing Address - Phone:812-867-8991
Mailing Address - Fax:812-867-8995
Practice Address - Street 1:13330 DARMSTADT RD
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47725-9593
Practice Address - Country:US
Practice Address - Phone:812-867-8991
Practice Address - Fax:812-867-8995
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2016-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71006642A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily