Provider Demographics
NPI:1619975604
Name:BULLOCK, LINDA NADENE (FNP)
Entity Type:Individual
Prefix:
First Name:LINDA
Middle Name:NADENE
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 119
Mailing Address - Street 2:
Mailing Address - City:SUDAN
Mailing Address - State:TX
Mailing Address - Zip Code:79371-0119
Mailing Address - Country:US
Mailing Address - Phone:806-227-2292
Mailing Address - Fax:806-227-2293
Practice Address - Street 1:208 W 2ND ST
Practice Address - Street 2:
Practice Address - City:MULESHOE
Practice Address - State:TX
Practice Address - Zip Code:79347-3631
Practice Address - Country:US
Practice Address - Phone:806-272-7736
Practice Address - Fax:806-227-2293
Is Sole Proprietor?:No
Enumeration Date:2005-07-13
Last Update Date:2022-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP103139363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
P13152Medicare UPIN
TX85N213Medicare PIN
TX142124001Medicaid