Individual
KELLY BULLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
DO
Contact information
Practice address
413 OWEN DR STE 201, FAYETTEVILLE, NC 28304-3490
(910) 323-9111
Mailing address
413 OWEN DR STE 201, FAYETTEVILLE, NC 28304-3490
(910) 323-9111
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
2023-01949
NC
390200000X
Student in an Organized Health Care Education/Training Program
Primary
—
—
Other
Enumeration date
03/26/2020
Last updated
06/08/2026
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