MEDICARE: KYM CULLAR, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	554888	TX

General Provider Information

NPI Number	:	1124261011
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KYM CULLAR, LLC

Provider Business Mailing Address
First Line	:	PO BOX 9889
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76308-9566
Country	:	US
Telephone Number	:	940-322-5477
Fax Number	:	940-720-0018

Provider Business Practice Location Address
First Line	:	1708 DAYTON AVE
Second Line	:
City	:	WICHITA FALLS
State	:	TX
Zip	:	76301-6110
Country	:	US
Telephone Number	:	940-322-5477
Fax Number	:	940-720-0018

Authorized Official
Title or Position	:	OWNER
Name	:	KYMBERLY CULLAR
Credential	:	APN
Telephone Number	:	940-322-5477

Provider Enumeration Date	:	04/08/2009
Last Update Date	:	01/10/2019

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