MARY KAY BULTMAN PMHNP NPI 1639627110

NPI Information

NPI: 1639627110
Provider Name: MARY KAY BULTMAN, PMHNP
Classification: Nurse Practitioner - 363LP0808X
Entity Type: Individual

Specialization: Psychiatric/Mental Health

PECOS Registration: Yes

Address:
1020 N 12TH ST FL 4
MILWAUKEE, WI
ZIP 53233
Phone: (414) 219-2000
Get Directions

Mary Kay Bultman, PMHNP is a psychiatric/mental health nurse practitioner in Milwaukee, WI with 8 years of experience. Mary Kay Bultman, PMHNP NPI is 1639627110. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

1020 N 12TH ST FL 4
MILWAUKEE, WI
ZIP 53233-308
Phone: (414) 219-2000
Fax: (414) 219-7402

The NPI 1639627110 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 9/14/2016 and was last updated on 3/6/2020.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	License Number	License State	Primary
1	363LP0808X	Nurse Practitioner	Psychiatric/Mental Health	60996-30	WISCONSIN	Yes
2	363L00000X	Nurse Practitioner		7252	WISCONSIN	No

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	100062610	MEDICAID	WISCONSIN
2	100080285	MEDICAID	WISCONSIN

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 4/28/2024

NPI Synchronization or Removal

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