Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207RH0002X | Hospice and Palliative Medicine | 2014-02005 | NC |
Y | 207RH0002X | Hospice and Palliative Medicine | 3283 | WV |
NPI | 1376863902 |
---|---|
Provider Name | Dr. Melissa Mclean Bullock |
First Address | Huntington, WV 25701-3804 |
Second Address | Huntington, WV 25701-3804 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2010 |
Last Update Date | 13/04/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0273518 | (05) | OH |
1376863902 | (05) | WV |
7100562030 | (05) | KY |