Provider Demographics
NPI:1679450779
Name:BULLINGTON, MIKAYLA ROSE
Entity type:Individual
Prefix:
First Name:MIKAYLA
Middle Name:ROSE
Last Name:BULLINGTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5846 S 385TH WEST AVE
Mailing Address - Street 2:
Mailing Address - City:MANNFORD
Mailing Address - State:OK
Mailing Address - Zip Code:74044-6443
Mailing Address - Country:US
Mailing Address - Phone:918-520-4888
Mailing Address - Fax:
Practice Address - Street 1:5846 S 385TH WEST AVE
Practice Address - Street 2:
Practice Address - City:MANNFORD
Practice Address - State:OK
Practice Address - Zip Code:74044-6443
Practice Address - Country:US
Practice Address - Phone:918-520-4888
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-19
Last Update Date:2025-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171400000XOther Service ProvidersHealth & Wellness Coach