Basic Information
| Provider Information | |||||||||
| NPI: | 1922365725 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BULLARD | ||||||||
| FirstName: | VERNEKA | ||||||||
| MiddleName: | EAOSHEA | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | MSW U/S, LMSW, BA | ||||||||
| OtherOrganizationName: | |||||||||
| OtherOrganizationType: | |||||||||
| OtherLastName: | BULLARD | ||||||||
| OtherFirstName: | VERNEKA | ||||||||
| OtherMiddleName: | EAOSHEA | ||||||||
| OtherNamePrefix: | MS. | ||||||||
| OtherNameSuffix: | |||||||||
| OtherCredential: | LCSW-P, LMSW, BA | ||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 4817 SE TATTERSHALL WAY | ||||||||
| Address2: | |||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735016431 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5806472006 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 4411 W GORE BLVD | ||||||||
| Address2: | SUITE B8 | ||||||||
| City: | LAWTON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735055977 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5806955596 | ||||||||
| FaxNumber: | 5806995950 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 04/18/2012 | ||||||||
| LastUpdateDate: | 04/05/2019 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 1041C0700X | 4043 | OK | Y | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.