MEDICARE: CHRISTY JOY MULLIN FNP-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	R157962	MD
2	363LF0000X	Family Nurse Practitioner	57766	WV

General Provider Information

NPI Number	:	1346301785
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHRISTY JOY MULLIN FNP-C

Provider Business Mailing Address
First Line	:	3790 HEDGESVILLE RD
Second Line	:	SUITE H
City	:	HEDGESVILLE
State	:	WV
Zip	:	25427-6704
Country	:	US
Telephone Number	:	304-754-7160
Fax Number	:	304-754-7244

Provider Business Practice Location Address
First Line	:	3790 HEDGESVILLE ROAD
Second Line	:	SUITE H
City	:	HEDGESVILLE
State	:	WV
Zip	:	25427-6704
Country	:	US
Telephone Number	:	304-754-7160
Fax Number	:	304-754-7244

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/12/2006
Last Update Date	:	03/11/2021

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