Provider Demographics
NPI:1386239812
Name:BULLOCK, JASMINE KELLY
Entity type:Individual
Prefix:
First Name:JASMINE
Middle Name:KELLY
Last Name:BULLOCK
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 1:8711 OAKDALE ST
Mailing Address - Street 2:
Mailing Address - City:FORT WASHINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20744-1812
Mailing Address - Country:US
Mailing Address - Phone:301-281-7242
Mailing Address - Fax:
Practice Address - Street 1:3700 9TH ST SE APT 227
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4015
Practice Address - Country:US
Practice Address - Phone:301-281-7242
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-06
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant