Provider Demographics
NPI:1841983103
Name:BULLOCK, BRITTANY ANN (DNP, APRN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:BRITTANY
Middle Name:ANN
Last Name:BULLOCK
Suffix:
Gender:F
Credentials:DNP, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:365 S CANYON OVERLOOK DR
Mailing Address - Street 2:
Mailing Address - City:TOOELE
Mailing Address - State:UT
Mailing Address - Zip Code:84074-3518
Mailing Address - Country:US
Mailing Address - Phone:435-830-7170
Mailing Address - Fax:
Practice Address - Street 1:28 N MAIN ST STE 3
Practice Address - Street 2:
Practice Address - City:TOOELE
Practice Address - State:UT
Practice Address - Zip Code:84074-2352
Practice Address - Country:US
Practice Address - Phone:435-830-7170
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-01
Last Update Date:2023-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7313239-3102163WP0808X
UT7313239-4405363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental HealthGroup - Single Specialty