Provider Demographics
NPI:1952065377
Name:BULLARD, LANORRIS
Entity Type:Individual
Prefix:
First Name:LANORRIS
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 1:224 HIGHWAY 425 S
Mailing Address - Street 2:
Mailing Address - City:MONTICELLO
Mailing Address - State:AR
Mailing Address - Zip Code:71655-4610
Mailing Address - Country:US
Mailing Address - Phone:870-224-8024
Mailing Address - Fax:870-224-8042
Practice Address - Street 1:224 HIGHWAY 425 S
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:AR
Practice Address - Zip Code:71655-4610
Practice Address - Country:US
Practice Address - Phone:870-224-8024
Practice Address - Fax:870-224-8042
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-22
Last Update Date:2021-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health