MARY KAY BULTMAN PMHNP
NPI 1639627110
Nurse Practitioner - Psychiatric/Mental Health in Milwaukee, WI

Q: What is Mary Kay Bultman's NPI number?

The NPI number for Mary Kay Bultman is 1639627110. It was assigned to this individual provider in the NPPES registry on September 14, 2016.

Q: What is Mary Kay Bultman's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Psychiatric/Mental Health, with taxonomy code 363LP0808X.

Q: When was this NPI record last updated?

The NPPES record for Mary Kay Bultman was last updated on March 6, 2020. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 6 years ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since September 14, 2016PECOS EnrolledAccepts Medicare Assignment

1020 N 12TH ST FL 4, MILWAUKEE, WI 53233(414) 219-2000(414) 219-7402 Get Directions Write a Review

NPPES record last updated: March 6, 2020. Verified against the NPPES registry weekly; last sync: August 02, 2026.

Record update history: Mar 6, 2020, Aug 26, 2019, Dec 6, 2018 and 2 more (5 updates tracked since 2016).

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About Mary Kay Bultman Pmhnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

MARY KAY BULTMAN PMHNP (NPI 1639627110) is an individual psychiatric/mental health provider in Milwaukee, Wisconsin, licensed in Wisconsin (60996-30) and active in the NPI registry since September 2016. She is enrolled in Medicare PECOS and is a graduate of Other (2016).

NPPES Registry Identity

NPI1639627110

Entity TypeIndividualFemale

Primary Taxonomy363LP0808X

Provider Legal NameMARY KAY BULTMANCredential: PMHNP

Location Address1020 N 12TH ST FL 4Milwaukee, WI 53233-1308

Mailing Address1020 N 12th St Fl 4Milwaukee, WI 53233-1308 · (414) 219-2000 · Fax (414) 219-7402

Phone(414) 219-2000

Fax(414) 219-7402

Sole ProprietorNo

Medical School CMSOtherGraduated 2016

Enumeration DateSeptember 14, 2016

Last NPPES UpdateMarch 6, 20205 updates tracked since enumeration

NPPES CertifiedMarch 6, 2020

✔ NPI 1639627110 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 2

★ Primary SpecialtyNurse Practitioner · Psychiatric/Mental HealthPhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LP0808X

License✔ Licensed in WI · 60996-30

Also ListedNurse PractitionerTaxonomy 363L00000X · License 7252 (WI)

1020 N 12TH ST FL 4, Milwaukee, WI 53233

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Other Identifiers 2

Medicaid100062610WI

Medicaid100080285WI

Accepted Insurance

The full list of accepted plans is on the Insurance tab. Issuers include Anthem Blue Cross and Blue Shield, CareSource (Common Ground Healthcare), HealthPartners and more.Insurance ›

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Mary Kay Bultman Pmhnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID4486934668

PECOS Enrollment IDI20241211000376

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 53233 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$82.92 typical visit price

range $53.90 – $163.24

Typical copayment $20.73 (range $13.47 – $40.81)

Most-billed visit code 99203

Established Patient

$95.41 typical visit price

range $17.40 – $133.76

Typical copayment $23.85 (range $4.35 – $33.44)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Other Providers at the Same Location NPPES 6

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

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