Individual
MRS. KIMBERLY SUE ELLEN BULLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FNP-BC
Contact information
Practice address
4503 MAIN ST STE 1, SHALLOTTE, NC 28470-4583
(910) 754-2273
(910) 754-2254
Mailing address
4503 MAIN ST STE 1, SHALLOTTE, NC 28470-4583
(910) 754-2273
(910) 754-2254
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
5023712
NC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
5023712
STATE
NC
Enumeration date
12/31/2025
Last updated
05/05/2026
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