MEDICARE: KARI LYNN BULLARD NP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	624760	TX

General Provider Information

NPI Number	:	1578994083
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KARI LYNN BULLARD NP-C

Provider Business Mailing Address
First Line	:	820 MONTGOMERY RD
Second Line	:
City	:	GRAHAM
State	:	TX
Zip	:	76450-4200
Country	:	US
Telephone Number	:	940-549-7741
Fax Number	:	940-549-6265

Provider Business Practice Location Address
First Line	:	820 MONTGOMERY RD
Second Line	:
City	:	GRAHAM
State	:	TX
Zip	:	76450-4200
Country	:	US
Telephone Number	:	940-549-7741
Fax Number	:	940-549-6265

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/09/2013
Last Update Date	:	12/09/2013

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