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

Mr. Kristopher Vaughn Pullam, MD

Individual provider Family Medicine Physician · NPI 1679067276

Mr. Kristopher Vaughn Pullam, MD is a Family Practice in Fenton, Missouri. Qualified in 2018, 8 years ago. Practices with Mercy Clinic East Communities, a 573-clinician group, works from 2 locations, accepts Medicare assignment and offers telehealth. Licensed in Missouri.

Years since qualifying
8
Licensed in
MO
In the registry since
2018
What do these letters mean?
MD — Doctor of Medicine
A physician who completed allopathic medical school.

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Practice location Address checks out

1203 Smizer Mill Rd Ste 105
Fenton, MO 63026-3483
Phone: (636) 717-1350
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Pin is approximate — placed at the ZIP-code centre, not the exact door.

Additional practice locations (1)

  • 621 S New Ballas Rd, Saint Louis, MO 63141-8232 — (314) 251-8888

Specialties & licences

Family Medicine Physician (primary) Taxonomy 207Q00000X · Licence 2021019546 (MO)

Record details

NPI number1679067276
Entity typeIndividual (Type 1)
GenderMale
Credentials MD
Sole proprietorYes
NPI enumeratedJune 18, 2018
Last updated in NPPESJune 8, 2021
Certification dateJune 8, 2021
Mailing address1203 Smizer Mill Rd Ste 105, Fenton, MO 63026-3483

Medicare enrollment

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

Medicare specialtyFAMILY PRACTICE
Medical schoolOTHER
Graduated 2018 (8 years in practice)
Group practice Mercy Clinic East Communities — 573 clinicians
Accepts Medicare assignment Yes — accepts the Medicare-approved amount
TelehealthOffers telehealth services

Other providers in Fenton