Provider Demographics
NPI:1801839568
Name:PULLIAM, CINDY ANNE (NP)
Entity type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:ANNE
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:NP
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 11407
Mailing Address - Street 2:DEPT #2130, UNIVERISTY PHYSICIANS
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35246-2130
Mailing Address - Country:US
Mailing Address - Phone:601-984-6525
Mailing Address - Fax:
Practice Address - Street 1:2500 NORTH STATE STREET
Practice Address - Street 2:DEPARTMENT OF ORTHOPEDICS
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216-4500
Practice Address - Country:US
Practice Address - Phone:601-984-6525
Practice Address - Fax:601-984-6764
Is Sole Proprietor?:No
Enumeration Date:2006-06-13
Last Update Date:2014-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR523364363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS0118514Medicaid
MS500003207 GRP CC1164OtherRAILROAD MEDICARE
MSP 00462309OtherRR MEDICARE
MS0118514Medicaid
MS512G700003Medicare UPIN
MSP01236801Medicare PIN
MS302I505880Medicare PIN
MS500000259Medicare ID - Type Unspecified
MS512I500086Medicare PIN