| NPI | 1275122897 |
|---|---|
| Former Name | TABITHA M BULLOCK |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | No |
| Primary Taxonomy | 363LF0000X Nurse Practitioner, Family (Licence: KY 3015937) |
| Additional Taxonomies | 163WG0000X Registered Nurse, General Practice (Licence: KY 1139295) |
| Enumeration Date | 2021-01-18 |
| Last Update Date | 2021-03-12 |