Active NPI
Kevin Floyd Ullom, RN
- Registered Nurse
- Saginaw, MI
National Provider Identifier
1104388719
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 4704128199
- Practice address
- 1320 N Michigan Ave Ste 5
Saginaw, MI 48602-4751 - Phone
- (989) 401-9015
- NPI assigned
- Apr 2, 2019
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 4704128199 | MI | Primary |
Addresses
Primary practice location
1320 N Michigan Ave Ste 5
Saginaw, MI 48602-4751
Mailing address
1320 N Michigan Ave Ste 5
Saginaw, MI 48602-4751
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 4704128199 | MI | MD | Registered Nurse |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1554163200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1554163200000",
"number": "1104388719",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1320 N MICHIGAN AVE STE 5",
"city": "SAGINAW",
"state": "MI",
"postal_code": "486024751"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1320 N MICHIGAN AVE STE 5",
"city": "SAGINAW",
"state": "MI",
"postal_code": "486024751",
"telephone_number": "989-401-9015"
}
],
"practiceLocations": [],
"basic": {
"last_name": "ULLOM",
"first_name": "KEVIN",
"middle_name": "FLOYD",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2019-04-02",
"last_updated": "2019-04-02",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "MI",
"license": "4704128199",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Saginaw, MI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 2, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.