Provider Demographics
NPI:1407015951
Name:BULLINGTON, TY A (NP)
Entity Type:Individual
Prefix:MR
First Name:TY
Middle Name:A
Last Name:BULLINGTON
Suffix:
Gender:M
Credentials:NP
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Mailing Address - Street 1:910 BLACKFORD STREET
Mailing Address - Street 2:ATTN: TCT AFTERCARE CENTER
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37403
Mailing Address - Country:US
Mailing Address - Phone:423-778-2846
Mailing Address - Fax:423-778-2877
Practice Address - Street 1:4519 HIXSON PIKE
Practice Address - Street 2:
Practice Address - City:HIXSON
Practice Address - State:TN
Practice Address - Zip Code:37343-5035
Practice Address - Country:US
Practice Address - Phone:423-877-4591
Practice Address - Fax:423-877-4225
Is Sole Proprietor?:No
Enumeration Date:2008-06-09
Last Update Date:2019-03-05
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN13114363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics