Provider Demographics
NPI:1861801755
Name:KULT, ROSE M (NP-C)
Entity type:Individual
Prefix:
First Name:ROSE
Middle Name:M
Last Name:KULT
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:ROSE
Other - Middle Name:M
Other - Last Name:BOGGESS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:10 POPE AVE
Mailing Address - Street 2:
Mailing Address - City:HILTON HEAD ISLAND
Mailing Address - State:SC
Mailing Address - Zip Code:29928-4719
Mailing Address - Country:US
Mailing Address - Phone:843-785-7786
Mailing Address - Fax:
Practice Address - Street 1:10 POPE AVE
Practice Address - Street 2:
Practice Address - City:HILTON HEAD ISLAND
Practice Address - State:SC
Practice Address - Zip Code:29928-4719
Practice Address - Country:US
Practice Address - Phone:843-785-7786
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-08-05
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95000881363LF0000X
SC22475363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily