Laura Ruthven Bulloch, PNP

Primary specialty

Pediatric Nurse PractitionerTaxonomy code 363LP0200X

License

19069 Issued in SC

Practice address

800 W Main St
Lake City, SC 29560-4400

Phone

(843) 977-7337

Fax

(843) 956-5415

NPI assigned

Sep 30, 2014

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

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 and National Provider Directory roles.

• Elm Pediatrics, LLC

  • Primary Care Clinic/Center
  • Lake City, SC
  • NPI 1255009163

  Pediatrics

  NPD
• Elm Pediatrics, LLC

  • Rural Health Clinic/Center
  • Lake City, SC
  • NPI 1457047581
  NPD

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

{
    "created_epoch": "1412035200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1663718400000",
    "number": "1700289147",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "800 W MAIN ST",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295604400",
            "telephone_number": "843-977-7337",
            "fax_number": "843-956-5415"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "800 W MAIN ST",
            "city": "LAKE CITY",
            "state": "SC",
            "postal_code": "295604400",
            "telephone_number": "843-977-7337",
            "fax_number": "843-956-5415"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLOCH",
        "first_name": "LAURA",
        "middle_name": "RUTHVEN",
        "credential": "PNP",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2014-09-30",
        "last_updated": "2022-09-21",
        "certification_date": "2022-09-21",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Pediatrics",
            "state": "SC",
            "license": "19069",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Caroline Morris Brown, PT, DPT
• Morris E Brown III, M.D.
• Tiffaney Medina Brown
• Jerena M Bryant
• Shargarticer S Bryant
• Deleon Jamaal Burch, PT
• De-Asia S Burroughs
• Lidia M Burroughs, PT
• Logan Brooke Burroughs
• Joseph Dan Bushardt Jr., RPH

• All providers in Lake City, SC
• Pediatric Nurse Practitioner in South Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 21, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.