Provider Demographics
NPI:1376512491
Name:BULLOCK, EMILY KATHARINE (NP)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:KATHARINE
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:EMILY
Other - Middle Name:KATHARINE
Other - Last Name:WARD
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:P.O. BOX 405827
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30384-5827
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:641 R B WILSON DR
Practice Address - Street 2:SUITE G
Practice Address - City:HUNTINGDON
Practice Address - State:TN
Practice Address - Zip Code:38344
Practice Address - Country:US
Practice Address - Phone:731-986-7400
Practice Address - Fax:731-986-7402
Is Sole Proprietor?:No
Enumeration Date:2006-03-14
Last Update Date:2016-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN6812363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
Q02398Medicare UPIN