Healthcare Provider Details

I. General information

NPI: 1316393382
Provider Name (Legal Business Name): ERIN KYLE CULLEFER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/10/2016
Last Update Date: 10/21/2020
Certification Date: 10/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2121 WARM SPRINGS RD
COLUMBUS GA
31904-7955
US

IV. Provider business mailing address

2121 WARM SPRINGS RD
COLUMBUS GA
31904-7955
US

V. Phone/Fax

Practice location:
  • Phone: 706-243-4500
  • Fax: 706-243-4504
Mailing address:
  • Phone: 62-434-5007
  • Fax: 706-243-4503

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License NumberRN20536
License Number StateGA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: