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NPI Code Detail

MEDICARE: KIMBERLY BROOKE BULLOCK

MEDICARE: KIMBERLY BROOKE 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
1246ZC0007XSurgical Assistant0136001137VA

General Provider Information

NPI Number : 1790633212
Entity Type Code : Individual
Provider Name (Legal Business Name) : KIMBERLY BROOKE BULLOCK
Provider Business Mailing Address
First Line : 7806 CHANCELLORS POND LN
Second Line :
City : FREDERICKSBURG
State : VA
Zip : 22407-8765
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 101 HOSPITAL CENTER BLVD
Second Line :
City : STAFFORD
State : VA
Zip : 22554-6200
Country : US
Telephone Number : 540-741-9000
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/19/2026
Last Update Date : 03/19/2026

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Directions to “ KIMBERLY BROOKE BULLOCK ” Practice Location

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