Provider Demographics
NPI:1558518050
Name:CORES, KAITLIN BULLOCK (MD)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:BULLOCK
Last Name:CORES
Suffix:
Gender:F
Credentials:MD
Other - Prefix:MISS
Other - First Name:KAITLIN
Other - Middle Name:ANNE
Other - Last Name:BULLOCK
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MD
Mailing Address - Street 1:7302 S YALE AVE
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-7027
Mailing Address - Country:US
Mailing Address - Phone:918-591-2510
Mailing Address - Fax:855-855-4102
Practice Address - Street 1:7302 S YALE AVE
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-7027
Practice Address - Country:US
Practice Address - Phone:918-591-2510
Practice Address - Fax:855-855-4102
Is Sole Proprietor?:No
Enumeration Date:2008-08-26
Last Update Date:2022-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK265532084P0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatry
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200224020BMedicaid
OKOKA103857Medicare PIN