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Individual
BRENT JAMES BULLOCK
Active
Individual
BRENT JAMES BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PMHNP, APRN
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
8695221-3102
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
8695221-4405
UT
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
8695221-8900
UT
Other
Enumeration date
12/29/2022
Last updated
08/10/2026
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