NPI 1114333093 · live from the CMS NPI Registry
Trisha Mae Bullard, PA-C, PTA
Physician Assistant, Surgical in St Johnsbury, VT. National Provider Identifier 1114333093, active.
NPI record
| NPI | 1114333093 Type 1 · individual |
|---|---|
| Status | Active |
| Primary specialty | Physician Assistant, Surgical 363AS0400X |
| Practice location | 1315 Hospital Dr, St Johnsbury, VT 05819 |
| Practice phone | 802-748-8141 |
| Mailing address | 128 Woodland Dr, Barre, VT 05641 |
| Enumerated | July 11, 2014 |
| Last updated | November 9, 2018 |
| Sole proprietor | No |
| Other names | Trisha Jewell |
Taxonomies and licenses
| Taxonomy | Code | License |
|---|---|---|
| Physical Therapy Assistant | 225200000X | 1054 (NH) |
| Physician Assistant, Surgical primary | 363AS0400X | 055.0031399 (VT) |
Source: CMS NPPES NPI Registry. NPI data is self-reported by providers; license numbers are not verified by CMS.