| Doctor Name: | MRS. TARA LEA BULLOCK |
| NPI Number: | 1063410710 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | ANP |
| License Number: | A01514 |
| Business Practice Address: | Rr 1 Box 371a London, AR - 728479602 |
| Business Phone Number: | 4799681245 |
| Business Fax Number: | 4799684137 |
| Mailing Address: | Rr 1 Box 371a, LONDON |
| State: | AR |
| Postal Code: | 728479602 |
| Phone Number: | 4799681245 |
| Fax Number: | 4799684137 |
| NPI Enumeration Date: | 07/07/2005 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | A01514 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | AR |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |