Individual
DR. KELLY LEIGH BULLOCK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
D.O.
Contact information
Practice address
106 E WAYNE ST, RANDOLPH, NE 68771-5300
(402) 337-0200
(402) 337-1020
Mailing address
1415 CHAROLAIS DRIVE, NORFOLK, NE 68701
(402) 379-1997
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
461
NE
Other
Enumeration date
10/03/2006
Last updated
02/15/2022
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