Individual provider Active NPI

Kaitlyn Elizabeth Bullock, FNP-C

  • Nurse Practitioner
  • Taunton, MA
National Provider Identifier
1992450118
Registry record updated Sep 1, 2024
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
RN2324940 Issued in MA
Practice address
2005 Bay St
Taunton, MA 02780-1085
Phone
(508) 828-7000
NPI assigned
Feb 16, 2022
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Sep 1, 2024

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X RN2324940 MA Primary

Addresses

Primary practice location

2005 Bay St
Taunton, MA 02780-1085

Mailing address

7 Marthas Vineyard Dr
Mattapoisett, MA 02739-1810
Phone (774) 291-9470

Other practice location 1

208 Mill Rd
Fairhaven, MA 02719-5208
Phone (774) 291-9470

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in MA
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
I20230921002529 MA Practitioner - Nurse Practitioner 0749667087 Reassigns benefits to 2 organizations

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2021
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Southcoast Physicians Group IncGroup PAC ID 0749171957, 875 clinicians

Practice addresses (Care Compare)

208 Mill Rd
Fairhaven, MA 02719-5208
Phone (508) 758-3781

Hospital & facility affiliations

  • Southcoast Hospitals Group Hospital, Fall River, MA, CCN 220074

National Provider Directory

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

Practice roles

OrganizationSpecialtyStatusNew patients
Steward Medical Group, Inc CurrentSince Jun 1, 2022 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Sep 5, 2023 Accepting new patients
Southcoast Physicians Group, Inc. Current Accepting new patients
Steward Medical Group, Inc CurrentSince Jun 1, 2022 Accepting new patients
Southcoast Physicians Group, Inc. CurrentSince Sep 5, 2023 Accepting new patients

Locations

11 Nevins St
Ste 201
Brighton, MA 02135
Phone (617) 789-2442

200 Mill Rd
Ste 180
Fairhaven, MA 02719
Phone (508) 973-2000

208 Mill Rd
Fairhaven, MA 02719
Phone (508) 758-3781

208 Mill Rd
#C
Fairhaven, MA 02719

534 Prospect St
Fall River, MA 02720
Phone (508) 679-7766

100 Amesbury St
Ste 103
Lawrence, MA 01840
Phone (978) 683-0157

2005 Bay St
Taunton, MA 02780
Phone (508) 822-2266

Interoperability endpoints

  • Direct secure messaging: kbullock70985@direct.southcoast.org

Organizations & group practices 5

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.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

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

{
    "created_epoch": "1644969600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1725148800000",
    "number": "1992450118",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7 MARTHAS VINEYARD DR",
            "city": "MATTAPOISETT",
            "state": "MA",
            "postal_code": "027391810",
            "telephone_number": "774-291-9470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "2005 BAY ST",
            "city": "TAUNTON",
            "state": "MA",
            "postal_code": "027801085",
            "telephone_number": "508-828-7000"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "208 Mill Rd",
            "address_purpose": "LOCATION",
            "city": "Fairhaven",
            "state": "MA",
            "postal_code": "027195208",
            "country_code": "US",
            "telephone_number": "774-291-9470",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "BULLOCK",
        "first_name": "KAITLYN",
        "middle_name": "ELIZABETH",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-02-16",
        "last_updated": "2024-09-01",
        "certification_date": "2024-09-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "MA",
            "license": "RN2324940",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Taunton, MA

Sources for this page

Verify at the official NPI Registry.