| Doctor Name: | CARA JEAN MCCULLAH |
| NPI Number: | 1497144968 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | RN, MSN, FNP-BC |
| License Number: | 3009180 |
| Business Practice Address: | 2702 Jacksboro Pike Jacksboro, TN - 377574850 |
| Business Phone Number: | 4232019937 |
| Business Fax Number: | |
| Mailing Address: | 270 Sharp Creek Rd, LA FOLLETTE |
| State: | TN |
| Postal Code: | 377666112 |
| Phone Number: | 8656171045 |
| Fax Number: | |
| NPI Enumeration Date: | 01/21/2015 |
| NPI Last Update Date: | 01/21/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 3009180 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | KY |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |