Provider Demographics
NPI:1306398409
Name:TULL, KELLY (WHNP)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:
Last Name:TULL
Suffix:
Gender:F
Credentials:WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22 NORTH DR
Mailing Address - Street 2:
Mailing Address - City:FISKDALE
Mailing Address - State:MA
Mailing Address - Zip Code:01518-1161
Mailing Address - Country:US
Mailing Address - Phone:812-236-7743
Mailing Address - Fax:
Practice Address - Street 1:22 NORTH DR
Practice Address - Street 2:
Practice Address - City:FISKDALE
Practice Address - State:MA
Practice Address - Zip Code:01518-1161
Practice Address - Country:US
Practice Address - Phone:812-236-7743
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-25
Last Update Date:2025-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT7658363LW0102X
IN28185781A363LW0102X
MARN2323729363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health