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NPI Code Detail

MEDICARE: KANDACE MARIE BULLAJIAN RN, MSN, FNP-BC

MEDICARE: KANDACE MARIE BULLAJIAN RN, MSN, FNP-BC
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
1363LF0000XFamily Nurse PractitionerAP116267TX
2363LF0000XFamily Nurse Practitioner720770TX

General Provider Information

NPI Number : 1033306303
Entity Type Code : Individual
Provider Name (Legal Business Name) : KANDACE MARIE BULLAJIAN RN, MSN, FNP-BC
Provider Business Mailing Address
First Line : PO BOX 848476
Second Line :
City : DALLAS
State : TX
Zip : 75284-8476
Country : US
Telephone Number : 254-202-4655
Fax Number : 254-202-4697
Provider Business Practice Location Address
First Line : 7300 BOSQUE BLVD
Second Line :
City : WACO
State : TX
Zip : 76710-4023
Country : US
Telephone Number : 254-202-2600
Fax Number : 254-202-2650
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 10/01/2007
Last Update Date : 12/02/2021

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