Provider Demographics
NPI:1083981757
Name:BULLIE, BIANCA ELAINE (FNP-C, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:BIANCA
Middle Name:ELAINE
Last Name:BULLIE
Suffix:
Gender:F
Credentials:FNP-C, PMHNP-BC
Other - Prefix:
Other - First Name:BIANCA
Other - Middle Name:
Other - Last Name:BULLIE-THOMPSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP-C, PMHNP-BC
Mailing Address - Street 1:1500 E WOODROW WILSON
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:MS
Mailing Address - Zip Code:39216
Mailing Address - Country:US
Mailing Address - Phone:601-362-4471
Mailing Address - Fax:601-368-4089
Practice Address - Street 1:1500 E WOODROW WILSON
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:MS
Practice Address - Zip Code:39216
Practice Address - Country:US
Practice Address - Phone:601-362-4471
Practice Address - Fax:601-368-4089
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-24
Last Update Date:2025-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS867841363LF0000X
MS2022153286363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
F1111175OtherNATIONAL NURSE PRACTITIONER LICENSE
MSRN867841OtherMS BOARD OF NURSING LICENSE NUMBER
2022153286OtherPMHNP - ANCC