Healthcare Provider Details

I. General information

NPI: 1679035851
Provider Name (Legal Business Name): MICHELLE KATHERINE BULL MSN, APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/04/2019
Last Update Date: 04/23/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

908 S JEFFERSON ST
WINCHESTER TN
37398-2132
US

IV. Provider business mailing address

100 WILLIAM NORTHERN BLVD
TULLAHOMA TN
37388-4754
US

V. Phone/Fax

Practice location:
  • Phone: 931-409-0620
  • Fax:
Mailing address:
  • Phone: 931-454-0489
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number25804
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: