Jessica Elaine Bullock, NP

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

2240 Issued in HI

Practice address

33 Lono Ave Ste 250
Kahului, HI 96732-1634

Phone

(808) 500-3439

NPI assigned

Apr 10, 2015

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 2

Other names 1

• Jessica Bullock Smith Former name

Medicare fee-for-service enrollment

Enrolled in HI

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, 2014

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Telehealth

Offers telehealth services

Group practices

Maui Care Physicians LLCGroup PAC ID 8820456825, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

Enrolled

Credentials

Nurse Practitioner

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jessica.bullock@594277412438020.direct.elationemr.com
• Direct secure messaging: jessica.bullock.p1@direct.wcchc.nextgenshare.com

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

• Maui Care Physicians LLC

  • Medical Oncology Physician
  • Makawao, HI
  • NPI 1659062107
  Medicare reassignment Care Compare group NPD
• Makana O Ka Ola Health and Wellness Clinic

  • Primary Care Clinic/Center
  • Wailuku, HI
  • NPI 1750832259
  NPD (past)

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

{
    "created_epoch": "1428624000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1745971200000",
    "number": "1609262278",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "33 LONO AVE STE 250",
            "city": "KAHULUI",
            "state": "HI",
            "postal_code": "967321634",
            "telephone_number": "808-500-3439"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "33 LONO AVE STE 250",
            "city": "KAHULUI",
            "state": "HI",
            "postal_code": "967321634",
            "telephone_number": "808-500-3439"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "JESSICA",
        "middle_name": "ELAINE",
        "credential": "NP",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-04-10",
        "last_updated": "2025-04-30",
        "certification_date": "2025-04-30",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "HI",
            "license": "2240",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "SC",
            "license": "19423",
            "primary": false
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "HI",
            "license": "2240",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "812778",
            "state": "HI"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "NP3164",
            "state": "SC"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "JESSICA",
            "last_name": "SMITH",
            "middle_name": "BULLOCK",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• William T. Brooks III, D.M.D.
• Kristina Leilani Brown, BCBA
• Reginald Glenn Buesa, MD
• Thomas Anh Bui, PHARMD
• Holly Bullock, MD, MPH
• Lourdes Agorra Butihi, RBT-21-179281
• Jessica Marie Bybee
• Rayna Noelani Cabingas, REGISTERED BEHAVIOR
• Jocelynn C Cala
• Jennifer Manrique Calibuso

• Family Nurse Practitioner in Kahului, HI
• Providers in Kahului, HI by specialty
• Family Nurse Practitioner in Hawaii

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 30, 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.