Provider Demographics
NPI:1720798580
Name:TULLIS, BAILEY LYNN (FNP)
Entity Type:Individual
Prefix:
First Name:BAILEY
Middle Name:LYNN
Last Name:TULLIS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:122 MOBLEY RD
Mailing Address - Street 2:
Mailing Address - City:BLOUNTVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37617-5429
Mailing Address - Country:US
Mailing Address - Phone:423-335-3245
Mailing Address - Fax:
Practice Address - Street 1:1009 NOVUS DR STE 1A
Practice Address - Street 2:
Practice Address - City:JOHNSON CITY
Practice Address - State:TN
Practice Address - Zip Code:37604-8237
Practice Address - Country:US
Practice Address - Phone:423-282-2516
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-01
Last Update Date:2022-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN32855363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty