Provider Demographics
NPI:1457715625
Name:KULOW, KALEB
Entity Type:Individual
Prefix:
First Name:KALEB
Middle Name:
Last Name:KULOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:965 E 700 S STE 300
Mailing Address - Street 2:
Mailing Address - City:ST GEORGE
Mailing Address - State:UT
Mailing Address - Zip Code:84790-4086
Mailing Address - Country:US
Mailing Address - Phone:435-673-4644
Mailing Address - Fax:
Practice Address - Street 1:965 E 700 S STE 300
Practice Address - Street 2:
Practice Address - City:ST GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84790-4086
Practice Address - Country:US
Practice Address - Phone:435-673-4644
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2024-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13889747-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner