Individual
JESSICA BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PMHNP, RN
Contact information
Practice address
4850 UNION AVE, SAN JOSE, CA 95124-5156
(800) 913-2615
Mailing address
4831 RIVERVALE DR, SOQUEL, CA 95073-9727
(503) 884-6518
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
201242077RN
OR
163W00000X
Registered Nurse
95146518
CA
363LP0808X
Psychiatric/Mental Health Nurse Practitioner
Primary
95019999
CA
Other
Enumeration date
11/10/2016
Last updated
10/16/2025
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