Provider Demographics
NPI:1952297293
Name:BULUS, JENNIFER TAKA (APRN PMHNP BC)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:TAKA
Last Name:BULUS
Suffix:
Gender:F
Credentials:APRN PMHNP BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:200 W COMMERCE ST APT 102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75208-1344
Mailing Address - Country:US
Mailing Address - Phone:903-941-5928
Mailing Address - Fax:
Practice Address - Street 1:1904 LONGMIRE RD STE 401
Practice Address - Street 2:
Practice Address - City:CONROE
Practice Address - State:TX
Practice Address - Zip Code:77304-5024
Practice Address - Country:US
Practice Address - Phone:281-724-7980
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-13
Last Update Date:2025-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1063676363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health