Provider Demographics
NPI:1194023010
Name:BULCOCK, JENNIFER C (MD)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:C
Last Name:BULCOCK
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:22450 S HARRISON ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66083-8882
Mailing Address - Country:US
Mailing Address - Phone:913-592-2720
Mailing Address - Fax:913-592-2725
Practice Address - Street 1:22450 S HARRISON ST STE 100
Practice Address - Street 2:
Practice Address - City:SPRING HILL
Practice Address - State:KS
Practice Address - Zip Code:66083-8882
Practice Address - Country:US
Practice Address - Phone:913-592-2720
Practice Address - Fax:913-592-2725
Is Sole Proprietor?:No
Enumeration Date:2011-03-01
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-41689207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine