Provider Demographics
NPI:1922700939
Name:BULLARD, ALYSSA LYN (MSN APRN FNP-C)
Entity Type:Individual
Prefix:
First Name:ALYSSA
Middle Name:LYN
Last Name:BULLARD
Suffix:
Gender:F
Credentials:MSN APRN FNP-C
Other - Prefix:
Other - First Name:ALYSSA
Other - Middle Name:LYN
Other - Last Name:ROXBURGH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7809 MCCULLOCH RD
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-6110
Mailing Address - Country:US
Mailing Address - Phone:678-361-6925
Mailing Address - Fax:
Practice Address - Street 1:60 DEL WEBB BLVD
Practice Address - Street 2:
Practice Address - City:GEORGETOWN
Practice Address - State:TX
Practice Address - Zip Code:78633-2488
Practice Address - Country:US
Practice Address - Phone:512-591-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1113042363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily