Blake David Bulger

Primary specialty

Psychiatric/Mental Health Nurse PractitionerTaxonomy code 363LP0808X

License

226137 Issued in AR

Practice address

10301 Mayo Dr
Barling, AR 72923-1660

Phone

(479) 494-5700

NPI assigned

Nov 21, 2022

Last updated

Sep 20, 2023By the provider in NPPES

Sex

Male

Sole proprietor

Yes

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in AR

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, 2023

Medicare assignment

May accept Medicare assignment

Telehealth

Offers telehealth services

Group practices

Ketamine and IV Therapy Clinic of Nwa LLCGroup PAC ID 6507308707, 12 clinicians

Valley Behavioral Health System LLCGroup PAC ID 2365693603, 4 clinicians

Practice addresses (Care Compare)

Medicare enrollment (NPD)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Ketamine and IV Therapy Clinic of Nwa LLC

  dba ascend wellness

  • Certified Registered Nurse Anesthetist
  • Lowell, AR
  • NPI 1609654847

  Psychiatric/Mental Health

  Medicare reassignment Care Compare group NPD
• Valley Behavioral Health System, LLC

  dba Valley Behavioral Health

  • Psychiatry Physician
  • Barling, AR
  • NPI 1528325651
  Medicare reassignment Care Compare group NPD
• Valley Behavioral Health System LLC

  dba Valley Behavioral Health

  • Psychiatric Hospital
  • Barling, AR
  • NPI 1982961439
  NPD

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

{
    "created_epoch": "1668988800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1695168000000",
    "number": "1861101586",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10301 MAYO DR",
            "city": "BARLING",
            "state": "AR",
            "postal_code": "729231660"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10301 MAYO DR",
            "city": "BARLING",
            "state": "AR",
            "postal_code": "729231660",
            "telephone_number": "479-494-5700"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "BULGER",
        "first_name": "BLAKE",
        "middle_name": "DAVID",
        "sole_proprietor": "YES",
        "sex": "M",
        "enumeration_date": "2022-11-21",
        "last_updated": "2023-09-20",
        "certification_date": "2023-09-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LP0808X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Psychiatric/Mental Health",
            "state": "AR",
            "license": "226137",
            "primary": true
        },
        {
            "code": "163W00000X",
            "taxonomy_group": "",
            "desc": "Registered Nurse",
            "state": "OK",
            "license": "206761",
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Amanda Brown
• Anna Lee Brown, LCSW
• Judy Brown, RN/MHPP
• Misha Brownlow
• Brent Bryant
• Khayyam Burns
• Jenny Burton, MHPP
• Cynthia Seaton Cagle, LCSW
• Ramona Cain-Brown
• Harley Paige Cain

• Psychiatric/Mental Health Nurse Practitioner in Barling, AR
• Providers in Barling, AR by specialty
• Psychiatric/Mental Health Nurse Practitioner in Arkansas

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 20, 2023; 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.