Provider Demographics
NPI:1548844616
Name:PULTS, KAITLYN (LM, CPM)
Entity type:Individual
Prefix:
First Name:KAITLYN
Middle Name:
Last Name:PULTS
Suffix:
Gender:
Credentials:LM, CPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3000 BANDOLINA AVE
Mailing Address - Street 2:
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-6610
Mailing Address - Country:US
Mailing Address - Phone:575-416-5203
Mailing Address - Fax:
Practice Address - Street 1:406 S LEA AVE
Practice Address - Street 2:
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88203-4564
Practice Address - Country:US
Practice Address - Phone:575-416-5203
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-05-05
Last Update Date:2025-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM22004R175M00000X, 175M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes175M00000XOther Service ProvidersMidwife, LayGroup - Single Specialty