Provider Demographics
NPI:1457715625
Name:KULOW, KALEB
Entity type:Individual
Prefix:
First Name:KALEB
Middle Name:
Last Name:KULOW
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1333 N MAIN ST STE 3
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-9314
Mailing Address - Country:US
Mailing Address - Phone:435-868-5656
Mailing Address - Fax:
Practice Address - Street 1:1333 N MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-9314
Practice Address - Country:US
Practice Address - Phone:435-868-5656
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-04-13
Last Update Date:2024-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT13889747-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner