Provider Demographics
NPI:1952871055
Name:PULLIAM, GLENDA (A-GNP)
Entity type:Individual
Prefix:MISS
First Name:GLENDA
Middle Name:
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:A-GNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4879 NAVY RD
Mailing Address - Street 2:
Mailing Address - City:MILLINGTON
Mailing Address - State:TN
Mailing Address - Zip Code:38053-2030
Mailing Address - Country:US
Mailing Address - Phone:704-449-6400
Mailing Address - Fax:877-800-9150
Practice Address - Street 1:4879 NAVY RD
Practice Address - Street 2:
Practice Address - City:MILLINGTON
Practice Address - State:TN
Practice Address - Zip Code:38053-2030
Practice Address - Country:US
Practice Address - Phone:704-449-6400
Practice Address - Fax:877-800-9150
Is Sole Proprietor?:No
Enumeration Date:2018-11-30
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5012679363LA2200X
TN32063363LA2200X, 363LG0600X
SC22404363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health