Individual provider Active NPI

Deborah M. Bullard, FNP-C

  • Family Nurse Practitioner
  • Wilmington, NC
National Provider Identifier
1801985205
Registry record updated Aug 8, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Family Nurse PractitionerTaxonomy code 363LF0000X
License
0050-02209 Issued in NC
Practice address
311-4E Judges Road
Wilmington, NC 28405-3655
Phone
(910) 791-6767
Fax
(910) 791-6890
NPI assigned
Oct 12, 2006
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Aug 8, 2013

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

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Family Nurse Practitioner 363LF0000X 0050-02209 NC Primary
Nurse Practitioner 363L00000X 165543 NC

Addresses

Primary practice location

311-4E Judges Road
Wilmington, NC 28405-3655

Mailing address

311-4E Judges Road
Wilmington, NC 28405-3655
Phone (910) 791-6767

Other identifiers 1

IdentifierTypeStateIssuer
6113081MedicaidNC

Medicare participation

Medicare enrollment files
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

Enrollment IDStateProvider typePAC IDDetails
I20070130000516 NC Practitioner - Nurse Practitioner 7810998036 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2006
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Pride in North Carolina LLCGroup PAC ID 9638105869, 34 clinicians

Practice addresses (Care Compare)

407 S Griffin St
Suite J
Elizabeth City, NC 27909-4693
Phone (252) 331-0322

4106 Shipyard Blvd
Wilmington, NC 28403-6155
Phone (910) 765-1785

5710 Oleander Dr
Wilmington, NC 28403-4722

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Nurse Practitioner

State licenses

LicenseStateTypeSpecialty
165543NCMDNurse Practitioner
0050-02209NCMDFamily Nurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Act Medical Group PA Past Accepting new patients
Act Medical Group, PA Past Accepting new patients

Organizations & group practices 3

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.

NPI Registry JSON

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

{
    "created_epoch": "1160611200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1375920000000",
    "number": "1801985205",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "311-4E JUDGES ROAD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284053655",
            "telephone_number": "910-791-6767",
            "fax_number": "910-791-6890"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311-4E JUDGES ROAD",
            "city": "WILMINGTON",
            "state": "NC",
            "postal_code": "284053655",
            "telephone_number": "910-791-6767",
            "fax_number": "910-791-6890"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULLARD",
        "first_name": "DEBORAH",
        "middle_name": "M.",
        "name_prefix": "Ms.",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-10-12",
        "last_updated": "2013-08-08",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "0050-02209",
            "primary": true
        },
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "165543",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "6113081",
            "state": "NC"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Wilmington, NC

Sources for this page

Verify at the official NPI Registry.