Provider Demographics
NPI:1346091964
Name:PULLIAM, FRANCINE (APRN)
Entity type:Individual
Prefix:
First Name:FRANCINE
Middle Name:
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 CARDINAL DR STE 314
Mailing Address - Street 2:
Mailing Address - City:ELIZABETHTOWN
Mailing Address - State:KY
Mailing Address - Zip Code:42701-2787
Mailing Address - Country:US
Mailing Address - Phone:270-706-1010
Mailing Address - Fax:270-706-5849
Practice Address - Street 1:200 CARDINAL DR STE 314
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-2787
Practice Address - Country:US
Practice Address - Phone:270-706-1010
Practice Address - Fax:270-706-5849
Is Sole Proprietor?:No
Enumeration Date:2024-04-01
Last Update Date:2025-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4016822363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100966190Medicaid