Provider Demographics
NPI:1992115901
Name:BULLINS, CHARLES MONROE II (AGACNP-BC)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:MONROE
Last Name:BULLINS
Suffix:II
Gender:M
Credentials:AGACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:625 DELAWARE ST
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:VA
Mailing Address - Zip Code:24153-5044
Mailing Address - Country:US
Mailing Address - Phone:540-589-6217
Mailing Address - Fax:
Practice Address - Street 1:201 CRYSTAL SPRING AVE SW
Practice Address - Street 2:SUITE 201
Practice Address - City:ROANOKE
Practice Address - State:VA
Practice Address - Zip Code:24104
Practice Address - Country:US
Practice Address - Phone:540-853-0100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-04-29
Last Update Date:2014-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024171785363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care