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Individual
TODD E BULLOCK
Active
Individual
TODD E BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
APRN
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
3004076
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000302145
ANTHEM
KY
01
—
2443164000
PASSPORT ADVANTAGE
KY
01
—
50001589
PASSPORT
KY
05
—
78010436
—
KY
Enumeration date
06/22/2005
Last updated
11/14/2018
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