Provider Demographics
NPI:1316147911
Name:BULKLEY, LARA CHRISTINE (CRNA)
Entity type:Individual
Prefix:MS
First Name:LARA
Middle Name:CHRISTINE
Last Name:BULKLEY
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:107 CYPRESS PT
Mailing Address - Street 2:
Mailing Address - City:PARAGOULD
Mailing Address - State:AR
Mailing Address - Zip Code:72450-7104
Mailing Address - Country:US
Mailing Address - Phone:870-476-0850
Mailing Address - Fax:870-240-8028
Practice Address - Street 1:1003 WINDOVER RD
Practice Address - Street 2:
Practice Address - City:JONESBORO
Practice Address - State:AR
Practice Address - Zip Code:72401-6007
Practice Address - Country:US
Practice Address - Phone:870-935-0861
Practice Address - Fax:870-972-5241
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2010-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR077543367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered