Provider Demographics
NPI:1245862424
Name:BULLARD, JORDAN KATE (NP)
Entity type:Individual
Prefix:
First Name:JORDAN
Middle Name:KATE
Last Name:BULLARD
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JORDAN
Other - Middle Name:KATE
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:NP
Mailing Address - Street 1:119 CROSSOVER RD
Mailing Address - Street 2:
Mailing Address - City:BEULAVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28518-8801
Mailing Address - Country:US
Mailing Address - Phone:910-298-3125
Mailing Address - Fax:
Practice Address - Street 1:119 CROSSOVER RD
Practice Address - Street 2:
Practice Address - City:BEULAVILLE
Practice Address - State:NC
Practice Address - Zip Code:28518-8801
Practice Address - Country:US
Practice Address - Phone:910-298-3125
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-02-06
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5013460363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics