Marlisa Bullock-Durham, NP

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

License

5011333 Issued in NC

Practice address

269 Gillman Rd Ste 100
Denver, NC 28037-7923

Phone

(704) 316-4930

Fax

(704) 316-4931

NPI assigned

Sep 23, 2013

Last updated

Jul 22, 2026By the provider in NPPES

Sex

Female

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Other names 1

• Marlisa Bullock Professional name

Electronic endpoints 1

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

Nurse Practitioner

Education

Other, 2013

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Novant Health Medical Group, LLCGroup PAC ID 1153234893, shared by 14 NPIs, 2,413 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: mbullock710095@direct.novanthealth.org

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.

• Novant Health Medical Group, LLC

  dba Novant Health Endocrinology

  • Endocrinology, Diabetes & Metabolism Physician
  • Charlotte, NC
  • NPI 1306950282
  Medicare reassignment NPD
• Novant Health Medical Group, LLC

  dba Novant Health Pediatric Neurology & Sleep

  • Neurology with Special Qualifications in Child Neurology Physician
  • Charlotte, NC
  • NPI 1366409492
  Medicare reassignment NPD
• Novant Health Medical Group, LLC

  dba Novant Health Neurology and Sleep

  • Neurology Physician
  • Matthews, NC
  • NPI 1083666887
  NPD
• Novant Health Medical Group, LLC

  dba Novant Health Elizabeth OB/GYN

  • Obstetrics & Gynecology Physician
  • Matthews, NC
  • NPI 1386506137
  NPD
• Novant Health Medical Group, LLC

  dba Novant Health Primary Care Gilead

  • Family Medicine Physician
  • Huntersville, NC
  • NPI 1992166771
  NPD
• Novant Medical Group, Inc.

  dba Mid Carolina Cardiology

  • Interventional Cardiology Physician
  • Charlotte, NC
  • NPI 1205836434
  NPD (past)

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

{
    "created_epoch": "1379894400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784678400000",
    "number": "1134555139",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 60447",
            "city": "CHARLOTTE",
            "state": "NC",
            "postal_code": "282600447"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "269 GILLMAN RD STE 100",
            "city": "DENVER",
            "state": "NC",
            "postal_code": "280377923",
            "telephone_number": "704-316-4930",
            "fax_number": "704-316-4931"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "32661 W. 13 mile",
            "address_purpose": "LOCATION",
            "city": "farmington hills",
            "state": "MI",
            "postal_code": "48334",
            "country_code": "US",
            "telephone_number": "313-268-7880",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BULLOCK-DURHAM",
        "first_name": "MARLISA",
        "credential": "NP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2013-09-23",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5011333",
            "primary": true
        },
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "MI",
            "license": "4704222885",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "mbullock710095@direct.novanthealth.org",
            "affiliation": "N",
            "address_1": "32661 W. 13 mile",
            "city": "farmington hills",
            "state": "MI",
            "country_code": "US",
            "postal_code": "48334",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": [
        {
            "first_name": "MARLISA",
            "last_name": "BULLOCK",
            "credential": "NP",
            "code": "2",
            "type": "Professional Name"
        }
    ]
}

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• Nurse Practitioner in Denver, NC
• Providers in Denver, NC by specialty
• Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2026; 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.