MEDICARE: TAMMY L CULLUM APRN

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	363L00000X	Nurse Practitioner	79321	KS
2	363L00000X	Nurse Practitioner	53-79321	KS
3	363LF0000X	Family Nurse Practitioner	79321	KS

General Provider Information

NPI Number	:	1699309120
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TAMMY L CULLUM APRN

Provider Business Mailing Address
First Line	:	2508 EDGEMONT DR STE 3
Second Line	:
City	:	ARKANSAS CITY
State	:	KS
Zip	:	67005-3844
Country	:	US
Telephone Number	:	620-741-5430
Fax Number	:	620-741-5431

Provider Business Practice Location Address
First Line	:	2508 EDGEMONT DR STE 3
Second Line	:
City	:	ARKANSAS CITY
State	:	KS
Zip	:	67005-3844
Country	:	US
Telephone Number	:	620-741-5430
Fax Number	:	620-741-5431

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

Provider Enumeration Date	:	02/24/2020
Last Update Date	:	09/13/2024

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