Provider Demographics
NPI:1679035851
Name:BULL, MICHELLE KATHERINE (MSN, APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:KATHERINE
Last Name:BULL
Suffix:
Gender:F
Credentials:MSN, APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 WILLIAM NORTHERN BLVD
Mailing Address - Street 2:
Mailing Address - City:TULLAHOMA
Mailing Address - State:TN
Mailing Address - Zip Code:37388-4754
Mailing Address - Country:US
Mailing Address - Phone:931-454-0489
Mailing Address - Fax:
Practice Address - Street 1:908 S JEFFERSON ST
Practice Address - Street 2:
Practice Address - City:WINCHESTER
Practice Address - State:TN
Practice Address - Zip Code:37398-2132
Practice Address - Country:US
Practice Address - Phone:931-409-0620
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-04
Last Update Date:2019-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN25804363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily