| Keinisha Bullard, CRNA | |
|
800 E Dawson St, Tyler, TX 75701-2036 | |
| (903) 531-4500 | |
| Not Available |
| Full Name | Keinisha Bullard |
|---|---|
| Gender | Female |
| Speciality | Certified Registered Nurse Anesthetist (crna) |
| Experience | 15 Years |
| Location | 800 E Dawson St, Tyler, Texas |
| Accepts Medicare Assignments | Yes. She accepts the Medicare-approved amount; you will not be billed for any more than the Medicare deductible and coinsurance. |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1649578451 | NPI | - | NPPES |
| 280340501 | Medicaid | TX | |
| 280340502 | Medicaid | TX | |
| 8283UB | Other | TX | BCBS |
| 750818167015 | Other | TX | TRICARE |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 367500000X | Nurse Anesthetist, Certified Registered | RN108766 (Louisiana) | Primary |
| Facility Name | Location | Facility Type |
|---|---|---|
| Ut Southwestern University Hospital - William P. Clements Jr. | Dallas, TX | Hospital |
| Group Practice Name | Group PECOS PAC ID | No. of Members |
|---|---|---|
| University Of Texas Southwestern Medical Center At Dallas | 0648188250 | 2784 |
| Entity Name | University Of Texas Southwestern Medical Center At Dallas |
|---|---|
| Entity Type | Part B Supplier - Clinic/group Practice |
| Entity Identifiers | NPI Number: 1942270566 PECOS PAC ID: 0648188250 Enrollment ID: O20031106000792 |
| Mailing Address | Practice Location Address |
|---|---|
| Keinisha Bullard, CRNA Po Box 841656, Dallas, TX 75284-1656 Ph: (903) 531-5000 | Keinisha Bullard, CRNA 800 E Dawson St, Tyler, TX 75701-2036 Ph: (903) 531-4500 |
Mrs. Glenda R Sealey, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1424 East Front, Tyler, TX 75702 Phone: 903-595-4144 Fax: 903-596-7541 | |
John Glynn Jeansonne, CRNA Nurse Anesthetist - CR Medicare: Medicare Enrolled Practice Location: 1000 S Beckham Ave, Tyler, TX 75701 Phone: 903-526-1068 Fax: 903-593-4290 | |
Jeffrey Manglicmot, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 800 E Dawson St, Tyler, TX 75701 Phone: 903-531-4522 | |
Harold Richie Bandalan, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1000 S Beckham Ave, Tyler, TX 75701 Phone: 903-526-1068 Fax: 903-593-4290 | |
Jeffrey David Barker, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 1000 S Beckham Ave, Tyler, TX 75701 Phone: 903-597-0351 | |
Gregory Mallett, Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 800 E Dawson St, Tyler, TX 75701 Phone: 903-606-4522 | |
Cara L Dewolfe, CRNA Nurse Anesthetist - CR Medicare: Accepting Medicare Assignments Practice Location: 800 E Dawson St, Tyler, TX 75701 Phone: 903-593-8441 |