SHADRICK BULLOCK NPI 1235025958

NPI Information

  • NPI: 1235025958
  • Provider Name: SHADRICK BULLOCK
  • Classification: Peer Specialist - 175T00000X
  • Entity Type: Individual
  • Address: 8344 N 117TH EAST AVE
    OWASSO, OK
    ZIP 74055
  • Phone: (918) 841-3794

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NPI Details

Shadrick Bullock is a peer specialist in Owasso, OK. The provider is individuals certified to perform peer support services through a training process defined by a government agency, such as the Department of Veterans Affairs or a state mental health department/certification/licensing authority. Shadrick Bullock NPI is 1235025958. The provider is registered as an individual entity type.

The NPPES NPI record indicates the provider is a male.

The provider's business location address is:

8344 N 117TH EAST AVE
OWASSO, OK
ZIP 74055-136
Phone: (918) 841-3794

The enumeration date for this NPI number is 6/17/2025 and was last updated on 6/17/2025.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No. Taxonomy Code Taxonomy Clasification Taxonomy Specialization License Number License State Primary
1175T00000XPeer SpecialistYes

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 11/21/2025

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