MR. WENDELL BART BULLOCK (NPI# 1689807612) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1689807612 |
| Entity Type | Individual |
| Full Name | MR. WENDELL BART BULLOCK |
| Other Name | MR. BART BULLOCK |
| Credential | PA-C |
| Practice Address |
104 Burney Dr Flowood MS 39232-6621 |
| Practice Telephone | 6019878200 |
| Practice Fax Number | 6019878211 |
| Mailing Telephone | 6019878200 |
| Mailing Fax Number | 6019878211 |
| Enumeration Date | 2009-08-25 |
| Last Update Date | 2020-10-14 |
| Gender Code | M |
| Is Sole Proprietor | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 363A00000X | Physician Assistant | PA00163 | MS | Physician Assistants & Advanced Practice Nursing Providers |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MS | 03856719 | 05 |
| Street Address |
104 BURNEY DR |
| City | FLOWOOD |
| State | MS |
| Zip Code | 39232-6621 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1104878669 | William Owen Mccraney | Orthopaedic Surgery | 104 Burney Dr, Flowood, MS 39232-6621 | 2006-05-16 |
| 1902377963 | Jeffrey Ray Duckworth | Nurse Practitioner | 104 Burney Dr, Flowood, MS 39232-6621 | 2018-12-16 |
| 1932676913 | Eric Tanner Long | Nurse Practitioner | 104 Burney Dr, Flowood, MS 39232-6621 | 2018-10-29 |
| 1588152920 | Specialty Surgical Center, LLC | Orthopaedic Surgery | 104 Burney Dr, Flowood, MS 39232 | 2018-05-01 |
| 1235671934 | Wendy Hamilton | Registered Nurse | 104 Burney Dr, Flowood, MS 39232-6621 | 2016-11-11 |
| 1396195848 | Klaye Clardy | Nurse Practitioner | 104 Burney Dr, Flowood, MS 39232-6621 | 2016-06-15 |
| 1417322439 | Jonathan Heath Thomas | Physical Therapist | 104 Burney Dr, Flowood, MS 39232-6621 | 2015-12-02 |
| 1124400411 | Rodney T Biggs | Registered Nurse | 104 Burney Dr, Flowood, MS 39232-6621 | 2015-06-23 |
| 1205174737 | Justin R. Goebel | Physician Assistant | 104 Burney Dr, Flowood, MS 39232-6621 | 2013-01-17 |
| 1609131838 | Hayley Barber Lohrisch | Physical Therapist | 104 Burney Dr, Flowood, MS 39232-6621 | 2012-07-13 |
| Find all providers in the same location | ||||
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1164071775 | Leanna Nicole Howard | Social Worker | 2945 Layfair Drive, Apt. 1621, Flowood, MS 39232 | 2019-09-06 |
| 1104395565 | Patriot Healthcare of Mississippi, LLC | Family Medicine | 4800 Lakeland Drive, Flowood, MS 39232 | 2018-11-15 |
| 1285101816 | Magnolia Anesthesia Consultants LLC | Anesthesiology | 4209 Lakeland Dr #252, Flowood, MS 39232 | 2018-11-01 |
| 1528543592 | Matthew T Armstrong | Physical Therapist | 104 Burney Drive, Flowood, MS 39232 | 2018-09-26 |
| 1790265627 | Mississippi Brain and Spine, Pllc | Non-Pharmacy Dispensing Site | 1 Layfair Drive, Ste 120, Flowood, MS 39232 | 2018-08-20 |
| 1629574918 | Billy Clifton Osbon Jr. | Pharmacist | 2506 Lakeland Drive, Suite 201, Flowood, MS 39232 | 2018-04-04 |
| 1356851752 | Oakdale Family Dentistry | Clinic/Center | 2139 Hwy 471, Flowood, MS 39232 | 2017-10-11 |
| 1992227177 | Charisma T. Cummings | Nurse Practitioner | 102 Riverview Drive, Suite A, Flowood, MS 39232 | 2017-07-10 |
| 1508398983 | Charles Pearson | Student in an Organized Health Care Education/Training Program | 764 Flowood Dr, Flowood, MS 39232 | 2017-04-03 |
| 1396288197 | Mary Claire Ponder | Nurse Practitioner | 151 E Metro Dr Ste 103, Flowood, MS 39232 | 2016-11-28 |
| Find all providers in zip 39232 | ||||
| Taxonomy Code | 363A00000X |
| Grouping | Physician Assistants & Advanced Practice Nursing Providers |
| Classification | Physician Assistant |
| A physician assistant is a person who has successfully completed an accredited education program for physician assistant, is licensed by the state and is practicing within the scope of that license. Physician assistants are formally trained to perform many of the routine, time-consuming tasks a physician can do. In some states, they may prescribe medications. They take medical histories, perform physical exams, order lab tests and x-rays, and give inoculations. Most states require that they work under the supervision of a physician. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1063479608 | Leah Jones Calder | Physician Assistant | 108 Belle Meade Pt, Flowood, MS 39232-3308 | 2006-04-27 |
| 1043634702 | Kristen Richardson | Physician Assistant | 108 Belle Meade Pt, Flowood, MS 39232-3308 | 2014-02-14 |
| 1205174737 | Justin R. Goebel | Physician Assistant | 104 Burney Dr, Flowood, MS 39232-6621 | 2013-01-17 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1831703958 | Melanie Layne Mccoy | Physician Assistant | 202 Joyce Ave, Long Beach, MS 39560-4332 | 2020-09-04 |
| 1437785482 | Kimberly Jordan Tupper | Physician Assistant | 6371 Shenandoah Ln, Olive Branch, MS 38654-3425 | 2020-03-20 |
| 1700419041 | Alexander Sorokin Flecker | Physician Assistant | 200b Eager St, Clinton, MS 39056-4545 | 2020-02-14 |
| 1548892904 | Meghan Seymour | Physician Assistant | 510 Glensview Dr, Brandon, MS 39047-7919 | 2020-02-04 |
| 1982234183 | Eva Mackenzie Carmody | Physician Assistant | 1190 N State St Suite 502, Jackson, MS 39202 | 2020-01-16 |
| 1477190668 | Kimberly Mcraney Watson | Physician Assistant | 907 Oakhill Cir, Clinton, MS 39056-3743 | 2019-12-06 |
| 1598301632 | Daniel Edward Bloom | Physician Assistant | Naval Branch Health Clinic Gulfport, 5502 Marvin Shields Blvd, Gulfport, MS 39501 | 2019-11-25 |
| 1467097956 | Chandler Stengel | Physician Assistant | 7900 Airways Blvd., Ste B102, Southaven, MS 38671-5809 | 2019-11-08 |
| 1922653526 | Lauren Ramsey | Physician Assistant | 845 E Scenic Dr, Pass Christian, MS 39571-4624 | 2019-08-09 |
| 1972161891 | Allison Taylor | Physician Assistant | 1850 Chadwick Drive, Suite 1427, North Tower, 4 West, Jackson, MS 39204-3404 | 2019-06-05 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.