Individual
MRS. TARA LEA BULLOCK
Active
Sole proprietor
Provider details
NPI number
Gender
F
Credential
ANP
Contact information
Practice address
RR 1 BOX 371A, LONDON, AR 72847-9602
(479) 968-1245
(479) 968-4137
Mailing address
RR 1 BOX 371A, LONDON, AR 72847-9602
(479) 968-1245
(479) 968-4137
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
A01514
AR
Other
Enumeration date
07/07/2005
Last updated
07/08/2007
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