TRACI A BULLOCK CRNP NPI 1124668132

NPI Information

  • NPI: 1124668132
  • Provider Name: TRACI A BULLOCK, CRNP
  • Classification: Nurse Practitioner - 363LF0000X
  • Specialization: Family
  • Entity Type: Individual
  • PECOS Registration: Yes
  • Address: 101 FITNESS WAY STE 1200
    ATHENS, AL
    ZIP 35611
  • Phone: (256) 236-0636

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NPI Details

Traci A Bullock, CRNP is a family nurse practitioner in Athens, AL with 6 years of experience. Traci A Bullock, CRNP NPI is 1124668132. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a female.

The provider's business location address is:

101 FITNESS WAY STE 1200
ATHENS, AL
ZIP 35611-492
Phone: (256) 236-0636
Fax: (256) 232-1281

The NPI 1124668132 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 1/8/2020 and was last updated on 1/8/2020.

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 PractitionerFamilyI28281ALABAMAYes

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
1I128481OTHERALABAMARN LICENSE

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: 3/30/2025

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