Provider Demographics
NPI:1447642517
Name:BULLOCK, CHAD (FNP-C)
Entity type:Individual
Prefix:
First Name:CHAD
Middle Name:
Last Name:BULLOCK
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8379 W SUNSET RD STE 210
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89113-2243
Mailing Address - Country:US
Mailing Address - Phone:725-200-3232
Mailing Address - Fax:725-220-6389
Practice Address - Street 1:8420 S EASTERN AVE STE 101
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89123-2875
Practice Address - Country:US
Practice Address - Phone:702-483-3554
Practice Address - Fax:725-267-1020
Is Sole Proprietor?:No
Enumeration Date:2015-02-26
Last Update Date:2023-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV001894363LF0000X
NVAPRN001894363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NV1447642517Medicaid
NVPENDINGMedicare PIN