Healthcare Provider Details

I. General information

NPI: 1528429289
Provider Name (Legal Business Name): CARRIE A. TULL, DPM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2016
Last Update Date: 03/09/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

272 REDWING DR
WINCHESTER KY
40391-2928
US

IV. Provider business mailing address

PO BOX 896
WINCHESTER KY
40392-0896
US

V. Phone/Fax

Practice location:
  • Phone: 859-737-0904
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code213E00000X
TaxonomyPodiatrist
License Number
License Number State

VIII. Authorized Official

Name: CARRIE TULL
Title or Position: DPM
Credential:
Phone: 715-367-9278