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General NPI Number Information
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NPI Number | 1952129397
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Entity Type | Individual
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Provider Name | MOLLY BETH BULLARD APRN
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Gender | Female
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Dates
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Enumeration Date | 10/02/2024
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Last Update Date | 10/02/2024
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Provider Practice Location Address
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Address Line | 1664 S CHOCTAW RD
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City | CHOCTAW
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State | OK
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Zip | 73020-6766
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Country | US
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Telephone | 405-963-3195
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Fax |
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Provider Business Mailing Address
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Address Line | 112 E 7TH ST
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City | ARCADIA
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State | OK
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Zip | 73007-9136
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Country | US
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Telephone | 405-693-3772
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | 216013
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License Number State | OK
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