Healthcare Provider Details

I. General information

NPI: 1073485041
Provider Name (Legal Business Name): JOSHUA SIMMS PULLIAM PNP-PC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/19/2025
Last Update Date: 09/19/2025
Certification Date: 09/18/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1151 HOSPITAL WAY BLDG F
POCATELLO ID
83201-5091
US

IV. Provider business mailing address

1151 HOSPITAL WAY BLDG F
POCATELLO ID
83201-5091
US

V. Phone/Fax

Practice location:
  • Phone: 202-232-1443
  • Fax:
Mailing address:
  • Phone: 208-232-1443
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number9071787
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: