Todd E Bullock, APRN | |
301 Sunset Dr, Caneyville, KY 42721-9172 | |
(270) 879-3711 | |
(270) 879-8674 |
Full Name | Todd E Bullock |
---|---|
Gender | Male |
Speciality | Nurse Practitioner - Family |
Location | 301 Sunset Dr, Caneyville, Kentucky |
Accepts Medicare Assignments | Medicare enrolled and may accept medicare through third-party reassignment. May prescribe medicare part D drugs. |
Identifier | Type | State | Issuer |
---|---|---|---|
1104822360 | NPI | - | NPPES |
000000302145 | Other | KY | ANTHEM |
2443164000 | Other | KY | PASSPORT ADVANTAGE |
50001589 | Other | KY | PASSPORT |
78010436 | Medicaid | KY |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
363LF0000X | Nurse Practitioner - Family | 3004076 (Kentucky) | Primary |
Entity Name | Twin Lakes Medical Foundation Inc |
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Entity Type | Part B Supplier - Clinic/group Practice |
Entity Identifiers | NPI Number: 1205870862 PECOS PAC ID: 3971591850 Enrollment ID: O20040501000241 |
Mailing Address | Practice Location Address |
---|---|
Todd E Bullock, APRN 908 Wallace Ave, Leitchfield, KY 42754-1479 Ph: (270) 259-1626 | Todd E Bullock, APRN 301 Sunset Dr, Caneyville, KY 42721-9172 Ph: (270) 879-3711 |
Andrea H. Marvel, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 301 Sunset Drive, Caneyville, KY 42721 Phone: 270-879-3711 | |
Crysta Devine, APRN Nurse Practitioner Medicare: Accepting Medicare Assignments Practice Location: 2207 Rabbit Flat Rd, Caneyville, KY 42721 Phone: 502-533-9110 | |
Shelly Geary, APRN Nurse Practitioner Medicare: Medicare Enrolled Practice Location: 4162 Falls Of Rough Rd, Caneyville, KY 42721 Phone: 270-879-3080 |