Individual
TRACIE L. BULLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
A.P.R.N.
Contact information
Practice address
1431 CENTERPOINT BLVD, KNOXVILLE, TN 37932-1984
(865) 985-7494
Mailing address
1431 CENTERPOINT BLVD, KNOXVILLE, TN 37932-1984
(865) 985-7494
Taxonomy
Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
3003142
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000000646027
BCBS
KY
05
—
78004785
—
KY
Enumeration date
10/23/2006
Last updated
05/15/2015
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