Provider Demographics
NPI:1508294315
Name:BULLARD, EMILY
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:BULLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 WESTPARK WAY
Mailing Address - Street 2:SUITE 300
Mailing Address - City:EULESS
Mailing Address - State:TX
Mailing Address - Zip Code:76040-3742
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:251 WESTPARK WAY
Practice Address - Street 2:SUITE 300
Practice Address - City:EULESS
Practice Address - State:TX
Practice Address - Zip Code:76040-3742
Practice Address - Country:US
Practice Address - Phone:817-868-6410
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-10-15
Last Update Date:2013-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXDT03609133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered