Provider Demographics
NPI:1356379960
Name:TULL, CARIE ANN (DPM)
Entity type:Individual
Prefix:DR
First Name:CARIE
Middle Name:ANN
Last Name:TULL
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1105 W 5TH ST
Mailing Address - Street 2:SUITE 3
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40741-1610
Mailing Address - Country:US
Mailing Address - Phone:859-887-8026
Mailing Address - Fax:859-887-0017
Practice Address - Street 1:208 BELLAIRE DR
Practice Address - Street 2:
Practice Address - City:NICHOLASVILLE
Practice Address - State:KY
Practice Address - Zip Code:40356-8840
Practice Address - Country:US
Practice Address - Phone:859-887-8026
Practice Address - Fax:859-887-0017
Is Sole Proprietor?:No
Enumeration Date:2006-06-30
Last Update Date:2016-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY00363213ES0103X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213ES0103XPodiatric Medicine & Surgery Service ProvidersPodiatristFoot & Ankle Surgery
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI43224900Medicaid
KY00363OtherLICENSE
KY00363OtherLICENSE
KY00363OtherLICENSE