Provider Demographics
NPI:1871882431
Name:PULLEY, CAROLYN YVONNE (NURSE PRACTITIONER,)
Entity type:Individual
Prefix:MRS
First Name:CAROLYN
Middle Name:YVONNE
Last Name:PULLEY
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER,
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:650 JOEL DR
Mailing Address - Street 2:
Mailing Address - City:FORT CAMPBELL
Mailing Address - State:KY
Mailing Address - Zip Code:42223-5318
Mailing Address - Country:US
Mailing Address - Phone:270-412-9370
Mailing Address - Fax:270-956-0444
Practice Address - Street 1:650 JOEL DR
Practice Address - Street 2:
Practice Address - City:FORT CAMPBELL
Practice Address - State:KY
Practice Address - Zip Code:42223-5318
Practice Address - Country:US
Practice Address - Phone:270-412-9370
Practice Address - Fax:270-956-0444
Is Sole Proprietor?:No
Enumeration Date:2011-04-05
Last Update Date:2025-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN158479163W00000X
TN15548171000000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No171000000XOther Service ProvidersMilitary Health Care Provider