Healthcare Provider Details

I. General information

NPI: 1548844616
Provider Name (Legal Business Name): KAITLYN PULTS LM, CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/05/2021
Last Update Date: 03/02/2025
Certification Date: 03/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

406 S LEA AVE
ROSWELL NM
88203-4564
US

IV. Provider business mailing address

3000 BANDOLINA AVE
ROSWELL NM
88201-6610
US

V. Phone/Fax

Practice location:
  • Phone: 575-416-5203
  • Fax:
Mailing address:
  • Phone: 575-416-5203
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code175M00000X
TaxonomyLay Midwife
License Number22004R
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: