Basic Information
| Provider Information | |||||||||
| NPI: | 1184769812 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BULLARD | ||||||||
| FirstName: | TRICIA | ||||||||
| MiddleName: | LOIS | ||||||||
| NamePrefix: | MS. | ||||||||
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| Credential: | MSN RN CPNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1502 SADDLECREEK DR | ||||||||
| Address2: | |||||||||
| City: | HOUSTON | ||||||||
| State: | TX | ||||||||
| PostalCode: | 770902136 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2813970388 | ||||||||
| FaxNumber: | 2813970388 | ||||||||
| Practice Location | |||||||||
| Address1: | 490 IH 10 N STE 100 | ||||||||
| Address2: | |||||||||
| City: | BEAUMONT | ||||||||
| State: | TX | ||||||||
| PostalCode: | 777021819 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4092129988 | ||||||||
| FaxNumber: | 4092128449 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/20/2007 | ||||||||
| LastUpdateDate: | 05/16/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LP0200X | AP105033 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics | 363LP0200X | 256934 | TX | N | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Pediatrics |
No ID Information.