Provider Demographics
NPI:1922844521
Name:BULLARD, SARA E (MS, RD)
Entity type:Individual
Prefix:
First Name:SARA
Middle Name:E
Last Name:BULLARD
Suffix:
Gender:F
Credentials:MS, RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:27580 SHILOH CROSSING RD
Mailing Address - Street 2:
Mailing Address - City:WISTER
Mailing Address - State:OK
Mailing Address - Zip Code:74966-5005
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6608 N WESTERN AVE # 1620
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-7326
Practice Address - Country:US
Practice Address - Phone:646-390-5066
Practice Address - Fax:646-390-2220
Is Sole Proprietor?:Yes
Enumeration Date:2024-07-02
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered