Individual
MRS. KELLY MICHELLE BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CRNA
Contact information
Practice address
1901 TATE SPRINGS RD, LYNCHBURG, VA 24501-1109
(704) 942-4854
Mailing address
100 KIMEL FOREST DR, WINSTON SALEM, NC 27103-6074
(336) 716-2255
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
0024181581
VA
367500000X
Certified Registered Nurse Anesthetist
121741
NC
367500000X
Certified Registered Nurse Anesthetist
Primary
5919
NC
Other
Enumeration date
06/18/2018
Last updated
03/03/2026
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