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NPI Code Detail

MEDICARE: VICTORIA MARY KERRY BULLOCK

MEDICARE: VICTORIA MARY KERRY BULLOCK
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
1363LA2100XAcute Care Nurse Practitioner26NJ15145600NJ
2363LA2100XAcute Care Nurse Practitioner5011817NC

General Provider Information

NPI Number : 1396303202
Entity Type Code : Individual
Provider Name (Legal Business Name) : VICTORIA MARY KERRY BULLOCK
Provider Business Mailing Address
First Line : 1126 NC 42 43 W
Second Line :
City : PINETOPS
State : NC
Zip : 27864-7182
Country : US
Telephone Number : 813-391-6282
Fax Number :
Provider Business Practice Location Address
First Line : 2100 STANTONSBURG RD
Second Line :
City : GREENVILLE
State : NC
Zip : 27834-2818
Country : US
Telephone Number : 252-572-2391
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/05/2019
Last Update Date : 05/28/2026

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Directions to “ VICTORIA MARY KERRY BULLOCK ” Practice Location

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