Active NPI
Kenneth Penn Bullard, MD
- Plastic Surgery Physician
- Charlotte, NC
National Provider Identifier
1851452296
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Plastic Surgery Physician
- License
- 15028
- Practice address
- 1225 Charter Place
Charlotte, NC 28211-5503 - Phone
- (704) 364-2358
- NPI assigned
- Dec 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Plastic Surgery Physician | 208200000X | 15028 | NC | Primary |
Addresses
Primary practice location
1225 Charter Place
Charlotte, NC 28211-5503
Mailing address
1225 Charter Place
Charlotte, NC 28211-5503
Phone (704) 364-2358
Other identifiers 3
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 19723 | Other | NC | BLUE CROSS BLUE SHIELD |
| 360677 | Medicaid | SC | |
| 8919723 | Medicaid | NC |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Doctor of Medicine
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 15028 | NC | MD | Plastic Surgery Physician |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1165881600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1851452296",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1225 CHARTER PLACE",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282115503",
"telephone_number": "704-364-2358"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1225 CHARTER PLACE",
"city": "CHARLOTTE",
"state": "NC",
"postal_code": "282115503",
"telephone_number": "704-364-2358"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BULLARD",
"first_name": "KENNETH",
"middle_name": "PENN",
"credential": "MD",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-12-12",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "208200000X",
"taxonomy_group": "",
"desc": "Plastic Surgery",
"state": "NC",
"license": "15028",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "BLUE CROSS BLUE SHIELD",
"identifier": "19723",
"state": "NC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "360677",
"state": "SC"
},
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "8919723",
"state": "NC"
}
],
"endpoints": [],
"other_names": []
}Other providers in Charlotte, NC
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.