Olivia Naomie Bullard
Individual provider Active NPI Physician Assistant · Fairmont, NC
NPI 1124815592 · NPPES record last updated May 12, 2025
Key facts
- NPI
- 1124815592
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Physician Assistant 363A00000X
- License
- 0010-15150 (NC)
- Practice address
- 210 S Walnut St
Fairmont, NC 28340-1956 - Phone
- (910) 628-6711
- Fax
- (910) 628-5735
- NPI assigned
- Apr 21, 2025
- Sex
- Female
- Sole proprietor
- No
Organizations & group practices 11
Hospital & facility affiliations 1
Medicare Care Compare profile
- Specialty
- Physician Assistant
- Education
- Other, 2024
- Medicare assignment
- Accepts the Medicare-approved amount as payment in full
- Group practices
- Robeson Health Care Corporation
Practice addresses (Care Compare)
210 S Walnut St
Fairmont, NC 28340-1956
Phone (910) 628-6711
302 Mount Tabor Rd
Red Springs, NC 28377-6415
Phone 91022728501124
Hospital & facility affiliations
- Southeastern Regional Medical Center
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NC
- Eligible to order & refer
- Part B services: Yes · DME: Yes · Home health: Yes · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20250715001644 | NC | Practitioner - Physician Assistant | 4486169885 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
- Credentials
- Physician Assistant
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 0010-15150 | NC | MD | Physician Assistant |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Robeson Health Care Corporation | Current | Accepting new patients | |
| Robeson Health Care Corporation | Current |
Accepting new patients | |
| Robeson Health Care Corporation | Current |
Accepting new patients | |
| Robeson Health Care Corporation | Past | Accepting new patients |
Locations
210 S Walnut St
Fairmont, NC 28340
Phone (910) 628-6711
1212 S Walnut St
Fairmont, NC 28340
Phone (910) 628-6711
610 E Dr Mlk Jr Dr
Maxton, NC 28364
Phone (910) 844-5253
307 E Wardell Dr
Pembroke, NC 28372
Phone (910) 521-2816
60 Commerce Plaza Cir
Pembroke, NC 28372
Phone (910) 521-2900
103 Cotton Creek Rd
Star, NC 27356
Phone (910) 226-4970
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 0010-15150 | NC | Yes |
Addresses
Primary practice location
210 S Walnut St
Fairmont, NC 28340-1956
Mailing address
60 Commerce Plaza Cir
Pembroke, NC 28372-7386
Phone (910) 521-2900
Other providers in Fairmont, NC
- Ashley Lannen Booth
- Ben Brady
- Bradys Pharmacy Inc
- Natural Morgan Breeden
- Mary Alexis Britt
- C & E Family Care Home LLC.
- Lionel Nelson Chamberlain
- Tammy Renea Chavis-Watson
- Kaila Brooke Chavis
- Children'S Health of Carolina, PA
All providers in Fairmont, NC · Physician Assistant in North Carolina
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on May 12, 2025. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- Medicare Fee-For-Service Public Provider Enrollment (CMS/PECOS): enrollments, PAC IDs and benefit reassignments.
- Order and Referring (CMS).
- Medicare Care Compare provider data (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.