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

Mary Kay Bultman, PMHNP

Individual provider Psychiatric/Mental Health Nurse Practitioner · NPI 1639627110

Mary Kay Bultman, PMHNP is a Nurse Practitioner in Milwaukee, Wisconsin. Qualified in 2016, 10 years ago. Practices with Lighthouse Clinic LLC, a 14-clinician group and accepts Medicare assignment. Licensed in Wisconsin.

Years since qualifying
10
Licensed in
WI
In the registry since
2016
Specialties on file
2
What do these letters mean?
PMHNP — Psychiatric-Mental Health Nurse Practitioner
A nurse practitioner specialising in mental health, able to prescribe psychiatric medication.

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Practice location Address checks out

1020 N 12th St Fl 4
Milwaukee, WI 53233-1308
Phone: (414) 219-2000
Fax: (414) 219-7402
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Specialties & licences

Psychiatric/Mental Health Nurse Practitioner (primary) Taxonomy 363LP0808X · Licence 60996-30 (WI)
Nurse Practitioner Taxonomy 363L00000X · Licence 7252 (WI)

Record details

NPI number1639627110
Entity typeIndividual (Type 1)
GenderFemale
Credentials PMHNP
Sole proprietorNo
NPI enumeratedSeptember 14, 2016
Last updated in NPPESMarch 6, 2020
Certification dateMarch 6, 2020

Medicare enrollment

From the CMS Doctors & Clinicians file — this clinician is enrolled in Medicare.

Medicare specialtyNURSE PRACTITIONER
Medical schoolOTHER
Graduated 2016 (10 years in practice)
Group practice Lighthouse Clinic Llc — 14 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
Practice locations2 on file with Medicare

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