Active NPI
Laurie Pullum, MSN, NP-C
- Nurse Practitioner
- Dexter, MO
National Provider Identifier
1609332089
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- 2018034585
- Practice address
- 12669 Regent Oak Dr
Dexter, MO 63841-9302 - Phone
- (573) 421-8855
- NPI assigned
- Feb 11, 2019
- Last updated
- Feb 11, 2019
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | 2018034585 | NV | Primary |
Addresses
Primary practice location
12669 Regent Oak Dr
Dexter, MO 63841-9302
Mailing address
12669 Regent Oak Dr
Dexter, MO 63841-9302
Phone (573) 421-8855
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
- Master of Science - Nursing
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2018034585 | NV | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1549843200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1549843200000",
"number": "1609332089",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "12669 REGENT OAK DR",
"city": "DEXTER",
"state": "MO",
"postal_code": "638419302",
"telephone_number": "573-421-8855"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "12669 REGENT OAK DR",
"city": "DEXTER",
"state": "MO",
"postal_code": "638419302",
"telephone_number": "573-421-8855"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PULLUM",
"first_name": "LAURIE",
"credential": "MSN, NP-C",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2019-02-11",
"last_updated": "2019-02-11",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "NV",
"license": "2018034585",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Dexter, MO
- Poplar Bluff Regional Medical Center, LLC (Dexter Medical Clinic)
- Practice Tee, LLC (Jibben Medical Clinic)
- Preferred Hospice of Missouri LLC (Preferred Hospice)
- Professional Counseling Group Inc
- Delaney Pullen, OD
- Kelly Pyle, P.T.
- Nyssa Quatmann, MA, BCBA, LBA
- Dana Leigh Reeder, PSYD
- Edward D Reese, M.D.
- Rickman Speech and Language LLC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 11, 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.