Nicholas Freeman Bullock
Individual provider Active NPI Family Nurse Practitioner · Pocatello, ID
NPI 1508299348 · NPPES record last updated Aug 15, 2013
Key facts
- NPI
- 1508299348
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Family Nurse Practitioner 363LF0000X
- License
- NP-1308A (ID)
- Practice address
- 777 Hospital Way
Pocatello, ID 83201-5175 - Phone
- (208) 239-1000
- NPI assigned
- Aug 15, 2013
- Sex
- Male
- Sole proprietor
- No
Organizations & group practices 3
Medicare participation
- Medicare fee-for-service enrollment
- Enrolled in NV
- Eligible to order & refer
- Part B services: No · DME: Yes · Home health: No · Power mobility devices: Yes · Hospice: No
Medicare enrollment records
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20221103002182 | NV | Practitioner - Nurse Practitioner | 9234363474 | Reassigns benefits to 1 organization |
National Provider Directory
- Medicare enrollment (NPD)
- Yes
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| American Current Care PA | Current | Accepting new patients | |
| American Current Care P.a. | Current |
Accepting new patients | |
| American Current Care PA | Current |
Accepting new patients |
Locations
149 N Gibson Rd
Ste H
Henderson, NV 89014
Phone (702) 558-6275
5850 Polaris Ave
Ste 100
Las Vegas, NV 89118
Phone (702) 739-9957
255 Glendale Ave
Ste 12
Sparks, NV 89431
Phone (775) 356-8181
5080 Spectrum Dr
Ste 1200W
Addison, TX 75001
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Family Nurse Practitioner | 363LF0000X | NP-1308A | ID | Yes |
| Occupational Health Nurse Practitioner | 363LX0106X | NP-1308A | ID |
Addresses
Primary practice location
777 Hospital Way
Pocatello, ID 83201-5175
Mailing address
777 Hospital Way
Pocatello, ID 83201-5175
Phone (208) 239-1000
Other providers in Pocatello, ID
- Jennie Brumfield
- Cathy Brydon
- Bryndon James Belnap DDS Ms PC
- Built Physical Therapy PC
- Kenton Buitenbos
- Cynthia Ann Bunde
- Jennifer Bunderson
- Jake Bundy
- Gregary Gradon Burch
- Maria Florencia Burgos
All providers in Pocatello, ID · Family Nurse Practitioner in Idaho
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Aug 15, 2013. 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).
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.