Healthcare Provider Details

I. General information

NPI: 1427731009
Provider Name (Legal Business Name): MR. CRAIG LAMAR HULL JR.
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2023
Last Update Date: 09/10/2026
Certification Date: 09/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 BRULE ST BLDG 871
FORT KNOX KY
40121-6100
US

IV. Provider business mailing address

200 BRULE ST BLDG 871
FORT KNOX KY
40121-6100
US

V. Phone/Fax

Practice location:
  • Phone: 502-624-9660
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: