Kim Lee McCullen, NP

Primary specialty

Neonatal Nurse PractitionerTaxonomy code 363LN0000X

License

4704207081 Issued in MI

Practice address

22101 Moross Rd
Detroit, MI 48236-2148

Phone

(313) 343-4400

NPI assigned

Oct 28, 2008

Last updated

Sep 14, 2020By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kmccullen684949@direct.hfhs.org

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• St. John Hospital and Medical Center

  • Long Term Care Hospital
  • Detroit, MI
  • NPI 1205986411
  Authorized official Same address or phone
• Henry Ford Macomb Hospital Corporation

  dba Henry Ford Macomb Health Center Chesterfield

  • Nurse Practitioner
  • Chesterfield, MI
  • NPI 1952440521
  NPD

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1225152000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1600041600000",
    "number": "1609029289",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "22101 MOROSS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362148",
            "telephone_number": "313-343-4000"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "22101 MOROSS RD",
            "city": "DETROIT",
            "state": "MI",
            "postal_code": "482362148",
            "telephone_number": "313-343-4400"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MCCULLEN",
        "first_name": "KIM",
        "middle_name": "LEE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-10-28",
        "last_updated": "2020-09-14",
        "certification_date": "2020-09-14",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LN0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal",
            "state": "MI",
            "license": "4704207081",
            "primary": true
        },
        {
            "code": "363LN0005X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Neonatal, Critical Care",
            "state": "MI",
            "license": "4704207081",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS GROUP 0N11180",
            "identifier": "4704207081",
            "state": "MI"
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Tajuanna McCright-Gilbert, MI000057505
• Icecis Lenora Christine McCrimmon
• Joyce Vernice McCroy
• Crystal McCue, PT, DPT
• Stephanie Lee McCullaugh
• Kennedy McCullers
• Apoorva McCulloch
• Thomas M McCullough, MD
• April McCullum
• Jamal McCullum

• Neonatal Nurse Practitioner in Detroit, MI
• Providers in Detroit, MI by specialty
• Neonatal Nurse Practitioner in Michigan

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 14, 2020; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.