Provider Demographics
NPI:1871244780
Name:BULLARD, BROOKE N (APRN)
Entity Type:Individual
Prefix:
First Name:BROOKE
Middle Name:N
Last Name:BULLARD
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21 W CENTRAL AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:OK
Mailing Address - Zip Code:74354-6815
Mailing Address - Country:US
Mailing Address - Phone:918-542-3900
Mailing Address - Fax:
Practice Address - Street 1:21 W CENTRAL AVE
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:OK
Practice Address - Zip Code:74354-6815
Practice Address - Country:US
Practice Address - Phone:918-542-3900
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-12
Last Update Date:2022-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKF06211819207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine