Provider Demographics
NPI:1699791871
Name:NULTON, CARNIE C (MD)
Entity type:Individual
Prefix:
First Name:CARNIE
Middle Name:C
Last Name:NULTON
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2330 SHAWNEE MISSION PKWY
Mailing Address - Street 2:SUITE 2201
Mailing Address - City:WESTWOOD
Mailing Address - State:KS
Mailing Address - Zip Code:66205-2005
Mailing Address - Country:US
Mailing Address - Phone:913-588-9800
Mailing Address - Fax:913-588-9803
Practice Address - Street 1:2330 SHAWNEE MISSION PKWY
Practice Address - Street 2:SUITE 2201
Practice Address - City:WESTWOOD
Practice Address - State:KS
Practice Address - Zip Code:66205-2005
Practice Address - Country:US
Practice Address - Phone:913-588-9800
Practice Address - Fax:913-588-9803
Is Sole Proprietor?:No
Enumeration Date:2006-07-14
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOR6H89207R00000X
KS04-25135207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
38419014OtherBCBS
KSP00407389OtherRR MEDICARE PIN
MO204894505Medicaid
KSP00407389OtherRR MEDICARE PIN
C51783Medicare UPIN
KSJ617276AMedicare PIN