Individual
MS. JACQUELINE WENONA BULLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
PTA
Contact information
Practice address
245 THORNTON RD, LOCKESBURG, AR 71846-9406
(405) 962-8447
Mailing address
245 THORNTON RD, LOCKESBURG, AR 71846-9406
(405) 962-8447
Taxonomy
Speciality
Code
Description
License number
State
225200000X
Physical Therapy Assistant
2386
OK
225200000X
Physical Therapy Assistant
Primary
4330
AR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
229517721
—
AR
Enumeration date
08/28/2018
Last updated
06/15/2023
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