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General NPI Number Information
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NPI Number | 1306394937
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Entity Type | Individual
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Provider Name | MARY K. BULLOCK APRN
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Gender | Female
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Dates
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Enumeration Date | 09/12/2016
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Last Update Date | 09/16/2025
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Provider Practice Location Address
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Address Line | 305 TAYLOR ST # 402
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City | BUTLER
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State | KY
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Zip | 41006-1042
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Country | US
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Telephone | 731-394-1145
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 269084 DEPT 1102
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City | OKLAHOMA CITY
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State | OK
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Zip | 73126
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 3010516
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 3010516
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License Number State | KY
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