=====================================================
General NPI Number Information
=====================================================
NPI Number | 1083573885
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHESLEY KELLY BULLIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/17/2026
-----------------------------------------------------
Last Update Date | 01/17/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 200 W ARMISTEAD DR
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39042-2856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-954-9799
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 200 W ARMISTEAD DR
-----------------------------------------------------
City | BRANDON
-----------------------------------------------------
State | MS
-----------------------------------------------------
Zip | 39042-2856
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 601-954-9799
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163W00000X
-----------------------------------------------------
Taxonomy Name | Registered Nurse
-----------------------------------------------------
License Number | 872128
-----------------------------------------------------
License Number State | MS
-----------------------------------------------------