Healthcare Provider Details

I. General information

NPI: 1154068849
Provider Name (Legal Business Name): REED BULLEN PA-C
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/16/2022
Last Update Date: 06/12/2026
Certification Date: 06/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1739 E BEVERLY AVE STE 204
KINGMAN AZ
86409-3593
US

IV. Provider business mailing address

1739 E BEVERLY AVE STE 204
KINGMAN AZ
86409-3593
US

V. Phone/Fax

Practice location:
  • Phone: 928-681-8715
  • Fax: 928-681-8716
Mailing address:
  • Phone: 385-626-3651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number9585
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: