Individual
EDWARD KULP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PAC
Contact information
Practice address
2115 STUART AVE, ALAMOSA, CO 81101-2269
(719) 589-8082
(719) 587-6354
Mailing address
106 BLANCA AVE, ALAMOSA, CO 81101-2340
(719) 589-8082
(719) 587-6354
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
1090
CO
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
65457820
—
CO
01
—
840706945074
ROCKY MOUNTAIN HEALTH PLA
CO
01
—
970027493
TRAVELERS MEDICARE
—
Enumeration date
10/21/2005
Last updated
05/06/2021
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