Provider Demographics
NPI:1083591846
Name:BULLARD, KERRY DEMETRIA
Entity type:Individual
Prefix:
First Name:KERRY
Middle Name:DEMETRIA
Last Name:BULLARD
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 ASHFORD DR
Mailing Address - Street 2:
Mailing Address - City:OXFORD
Mailing Address - State:GA
Mailing Address - Zip Code:30054-4646
Mailing Address - Country:US
Mailing Address - Phone:706-816-5346
Mailing Address - Fax:
Practice Address - Street 1:110 ASHFORD DR
Practice Address - Street 2:
Practice Address - City:OXFORD
Practice Address - State:GA
Practice Address - Zip Code:30054-4646
Practice Address - Country:US
Practice Address - Phone:706-816-5346
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-08-21
Last Update Date:2025-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN721378163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse