Provider Demographics
NPI:1861592362
Name:BULTEMEIER, KAYE I (NP)
Entity type:Individual
Prefix:
First Name:KAYE
Middle Name:I
Last Name:BULTEMEIER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 NEW YORK AVE STE 150
Mailing Address - Street 2:
Mailing Address - City:OAK RIDGE
Mailing Address - State:TN
Mailing Address - Zip Code:37830-5227
Mailing Address - Country:US
Mailing Address - Phone:865-481-0500
Mailing Address - Fax:865-481-3085
Practice Address - Street 1:200 NEW YORK AVE STE 150
Practice Address - Street 2:
Practice Address - City:OAK RIDGE
Practice Address - State:TN
Practice Address - Zip Code:37830-5227
Practice Address - Country:US
Practice Address - Phone:865-481-0200
Practice Address - Fax:865-481-3085
Is Sole Proprietor?:No
Enumeration Date:2006-09-24
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000005372363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3907576Medicare PIN
TNP16100Medicare UPIN