Provider Demographics
NPI:1013414390
Name:BULKLEY, MELINDA (LVN)
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:
Last Name:BULKLEY
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:615 PARK CREEK AVE
Mailing Address - Street 2:
Mailing Address - City:FORNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75126-9239
Mailing Address - Country:US
Mailing Address - Phone:972-750-8783
Mailing Address - Fax:
Practice Address - Street 1:615 PARK CREEK AVE
Practice Address - Street 2:
Practice Address - City:FORNEY
Practice Address - State:TX
Practice Address - Zip Code:75126-9239
Practice Address - Country:US
Practice Address - Phone:972-750-8783
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-12
Last Update Date:2018-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX306567164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse