Individual
COURTNEY BULLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
AGNP-C
Contact information
Practice address
60 PHYSICIANS LN, SOUTHAVEN, MS 38671-6122
(662) 688-5510
Mailing address
60 PHYSICIANS LN, SOUTHAVEN, MS 38671-6122
(662) 688-5510
Taxonomy
Speciality
Code
Description
License number
State
363LA2200X
Adult Health Nurse Practitioner
Primary
903421
MS
363LG0600X
Gerontology Nurse Practitioner
903421
MS
Other
Enumeration date
07/17/2019
Last updated
07/19/2024
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