MEDICARE: SUMMER BULLARD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	175T00000X	Peer Specialist		OK

General Provider Information

NPI Number	:	1245187111
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SUMMER BULLARD

Provider Business Mailing Address
First Line	:	3505 WILLOW SPRINGS DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-3165
Country	:	US
Telephone Number	:	405-724-5222
Fax Number	:

Provider Business Practice Location Address
First Line	:	3505 WILLOW SPRINGS DR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-3165
Country	:	US
Telephone Number	:	405-724-5222
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/11/2026
Last Update Date	:	03/11/2026

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Directions to “ SUMMER BULLARD ” Practice Location

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