Individual
KEINISHA BULLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
800 E DAWSON ST, TYLER, TX 75701-2036
(903) 531-4500
Mailing address
PO BOX 841656, DALLAS, TX 75284-1656
(903) 531-5000
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
RN108766
LA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
280340501
—
TX
05
—
280340502
—
TX
01
—
750818167015
TRICARE
TX
01
—
8283UB
BCBS
TX
Enumeration date
03/02/2011
Last updated
10/14/2014
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