Provider Demographics
NPI:1427284462
Name:PULLIAM, RIKKINA (FNP)
Entity type:Individual
Prefix:
First Name:RIKKINA
Middle Name:
Last Name:PULLIAM
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2480 LLEWELLYN AVE
Mailing Address - Street 2:KIMBROUGH AMBULATORY CARE CENTER BLUE TEAM
Mailing Address - City:FORT GEORGE G MEADE
Mailing Address - State:MD
Mailing Address - Zip Code:20755-7081
Mailing Address - Country:US
Mailing Address - Phone:301-677-8897
Mailing Address - Fax:301-677-8299
Practice Address - Street 1:2480 LLEWELLYN AVE
Practice Address - Street 2:KIMBROUGH AMBULATORY CARE CENTER BLUE TEAM
Practice Address - City:FORT GEORGE G MEADE
Practice Address - State:MD
Practice Address - Zip Code:20755-7081
Practice Address - Country:US
Practice Address - Phone:301-677-8897
Practice Address - Fax:301-677-8299
Is Sole Proprietor?:No
Enumeration Date:2009-06-04
Last Update Date:2009-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1079812363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
VAD000Medicare UPIN