Kimberly Diane Pullen, P.A.

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

PA06489 Issued in TX

Practice address

4701 Boat Club Rd., Suite 200
Fort Worth, TX 76135-5285

Phone

(817) 237-0515

NPI assigned

Dec 9, 2009

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in TX

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: kpullen1288318@direct.texashealth.org

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

• Texas Health Physicians Group

  • Internal Medicine Physician
  • Fort Worth, TX
  • NPI 1174573596
  Medicare reassignment
• Texas Health Physicians Group

  • Sleep Disorder Diagnostic Clinic/Center
  • Dallas, TX
  • NPI 1174992051
  NPD

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

{
    "created_epoch": "1260316800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1645747200000",
    "number": "1881923530",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4701 BOAT CLUB RD., SUITE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761355285",
            "telephone_number": "817-237-0515"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4701 BOAT CLUB RD., SUITE 200",
            "city": "FORT WORTH",
            "state": "TX",
            "postal_code": "761355285",
            "telephone_number": "817-237-0515"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "PULLEN",
        "first_name": "KIMBERLY",
        "middle_name": "DIANE",
        "credential": "P.A.",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-12-09",
        "last_updated": "2022-02-25",
        "certification_date": "2022-02-15",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "TX",
            "license": "PA06489",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "kpullen1288318@Direct.texashealth.org",
            "affiliation": "N",
            "endpointDescription": "hie",
            "use": "HIE",
            "useDescription": "Health Information Exchange (HIE)",
            "address_1": "4701 Boat Club Rd., Suite 200",
            "city": "Fort Worth",
            "state": "TX",
            "country_code": "US",
            "postal_code": "761355285",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Alyssa Renelle Pugh, CRNA
• Billie Raymond Pugh Jr., MD
• Srinivas Reddy Puli, M.D
• Mia Elena Pulido
• Rhizhene Pullen-Parmes
• Janice Pulliam, RN
• Pulmcare, LLC
• Pulse Primary Care of Texas PLLC
• John Andrew Pumphrey, M.D.
• Punjab Power Corp

• Physician Assistant in Fort Worth, TX
• Providers in Fort Worth, TX by specialty
• Physician Assistant in Texas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Feb 25, 2022; 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.