Provider Demographics
NPI:1821362252
Name:BULLARD, CRISTY A
Entity Type:Individual
Prefix:
First Name:CRISTY
Middle Name:A
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 1:2637 EDENBORN AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:METAIRIE
Mailing Address - State:LA
Mailing Address - Zip Code:70002-7045
Mailing Address - Country:US
Mailing Address - Phone:504-455-2446
Mailing Address - Fax:504-455-7626
Practice Address - Street 1:2637 EDENBORN AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70002-7045
Practice Address - Country:US
Practice Address - Phone:504-455-2446
Practice Address - Fax:504-455-7626
Is Sole Proprietor?:No
Enumeration Date:2012-03-02
Last Update Date:2012-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes172V00000XOther Service ProvidersCommunity Health Worker