MEDICARE: KIMBERLY KAY BULL

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	376J00000X	Homemaker

General Provider Information

NPI Number	:	1417874777
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY KAY BULL

Provider Business Mailing Address
First Line	:	1040 OLD 35
Second Line	:
City	:	XENIA
State	:	OH
Zip	:	45385-7846
Country	:	US
Telephone Number	:	937-604-2467
Fax Number	:

Provider Business Practice Location Address
First Line	:	1040 OLD 35
Second Line	:
City	:	XENIA
State	:	OH
Zip	:	45385-7846
Country	:	US
Telephone Number	:	937-604-2467
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/29/2026
Last Update Date	:	06/29/2026

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Directions to “ KIMBERLY KAY BULL ” Practice Location

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