Olivia Naomie Bullard

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

0010-15150 Issued in NC

Practice address

210 S Walnut St
Fairmont, NC 28340-1956

Phone

(910) 628-6711

Fax

(910) 628-5735

NPI assigned

Apr 21, 2025

Last updated

May 12, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Specialty

Physician Assistant

Education

Other, 2024

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Robeson Health Care CorporationGroup PAC ID 1850290693, 24 clinicians

Practice addresses (Care Compare)

Hospital & facility affiliations

• Southeastern Regional Medical Center Hospital, Lumberton, NC, CCN 340050

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

Locations

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Robeson Health Care Corporation

  dba Julian T Pierce Health Center

  • Federally Qualified Health Center (FQHC)
  • Pembroke, NC
  • NPI 1750348538
  Medicare reassignment Care Compare group NPD (past)
• Robeson Health Care Corporation

  dba Maxton Medical Center

  • Federally Qualified Health Center (FQHC)
  • Maxton, NC
  • NPI 1093772410
  NPD
• Robeson Health Care Corporation

  dba Fairmont Family Dental

  • Federally Qualified Health Center (FQHC)
  • Fairmont, NC
  • NPI 1184490104
  NPD
• Robeson Health Care Corporation

  dba Lumberton Health Center

  • Federally Qualified Health Center (FQHC)
  • Lumberton, NC
  • NPI 1184681496
  NPD

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

• Southeastern Regional Medical Center

  dba UNC Health Southeastern

  • General Acute Care Hospital
  • Lumberton, NC
  • NPI 1427030774
  Care Compare affiliation

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1745193600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1747008000000",
    "number": "1124815592",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "60 COMMERCE PLAZA CIR",
            "city": "PEMBROKE",
            "state": "NC",
            "postal_code": "283727386",
            "telephone_number": "910-521-2900"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "210 S WALNUT ST",
            "city": "FAIRMONT",
            "state": "NC",
            "postal_code": "283401956",
            "telephone_number": "910-628-6711",
            "fax_number": "910-628-5735"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLARD",
        "first_name": "OLIVIA",
        "middle_name": "NAOMIE",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2025-04-21",
        "last_updated": "2025-05-12",
        "certification_date": "2025-05-12",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-15150",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Ashley Lannen Booth, HSP-PA
• Ben Brady, RPH
• Bradys Pharmacy Inc (Websters Pharmacy)
• Natural Morgan Breeden, LCSWA
• Mary Alexis Britt
• C & E Family Care Home LLC.
• Lionel Nelson Chamberlain, OD
• Tammy Renea Chavis-Watson, FNP
• Kaila Brooke Chavis
• Children's Health of Carolina, PA (Children's Health Fairmont)

• Physician Assistant in Fairmont, NC
• Providers in Fairmont, NC by specialty
• Physician Assistant in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 12, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.