TODD E BULLOCK APRN NPI 1104822360

NPI Information

  • NPI: 1104822360
  • Provider Name: TODD E BULLOCK, APRN
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 301 SUNSET DR
    CANEYVILLE, KY
    ZIP 42721
  • Phone: (270) 879-3711

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NPI Details

Todd E Bullock, APRN is a family nurse practitioner in Caneyville, KY with 23 years of experience. Todd E Bullock, APRN NPI is 1104822360. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

301 SUNSET DR
CANEYVILLE, KY
ZIP 42721-172
Phone: (270) 879-3711
Fax: (270) 879-8674

The NPI 1104822360 is registered in the Medicare Provider, Enrollment, Chain and Ownership System (PECOS). The provider is legally eligible to order and refer Part B (Clinical Laboratory and Imaging), Durable Medical Equipment, Part A Home Health Agency (HHA), Power Mobility Devices.

The enumeration date for this NPI number is 6/22/2005 and was last updated on 11/14/2018.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1363LF0000XNurse PractitionerFamily3004076KENTUCKYYes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No. Other Provider Identifier Other Provider Identifier Type Other Provider Identifier State Other Provider Identifier Issuer
150001589OTHERKENTUCKYPASSPORT
22443164000OTHERKENTUCKYPASSPORT ADVANTAGE
378010436MEDICAIDKENTUCKY
4000000302145OTHERKENTUCKYANTHEM

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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