Individual
KEVAN PATRICK MCCULLUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Contact information
Practice address
908 DUPONT RD, LOUISVILLE, KY 40207-4602
(502) 749-7909
Mailing address
PO BOX 909, LOUISVILLE, KY 40201-0909
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3015146
KY
Other
Enumeration date
09/17/2020
Last updated
09/22/2020
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