| Doctor Name: | KIM MCCULLOUGH |
| NPI Number: | 1174970487 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | F.N.P. |
| License Number: | 71006232A |
| Business Practice Address: | 1002 S Edgewood Dr Knox, IN - 465348226 |
| Business Phone Number: | 5747726030 |
| Business Fax Number: | 5747727494 |
| Mailing Address: | 1002 S Edgewood Dr, KNOX |
| State: | IN |
| Postal Code: | 465348226 |
| Phone Number: | 5747726030 |
| Fax Number: | 5747727494 |
| NPI Enumeration Date: | 05/17/2016 |
| NPI Last Update Date: | 05/17/2016 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 71006232A |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | IN |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |