Provider records sourced from NPPES (CMS National Plan & Provider Enumeration System). Data current as of August 10, 2026.

Kelly Bultman

Individual provider Physician Assistant · NPI 1104491414

Kelly Bultman is a Physician Assistant in Beavercreek, Ohio. Practices as a sole proprietor and works from 2 locations. Licensed in Ohio.

Licensed in
OH
In the registry since
2021

Practice location Address checks out

2510 Commons Blvd Ste 210
Beavercreek, OH 45431-3821
Phone: (513) 833-4912
Show map & directions

Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 4956 Jessica Suzanne Dr, Morrow, OH 45152-8056 — (513) 833-4912

Specialties & licences

Physician Assistant (primary) Taxonomy 363A00000X · Licence 50.006573RX (OH)

Record details

NPI number1104491414
Entity typeIndividual (Type 1)
GenderFemale
Sole proprietorYes
NPI enumeratedMay 20, 2021
Last updated in NPPESJuly 22, 2022
Certification dateJuly 22, 2022
Mailing address2510 Commons Blvd Ste 210, Beavercreek, OH 45431-3821

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