Healthcare Provider Details

I. General information

NPI: 1376987719
Provider Name (Legal Business Name): JULIA A MULLENAX APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: JULIE MULLENAX APN

II. Dates (important events)

Enumeration Date: 04/27/2013
Last Update Date: 04/27/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4301 W MARKHAM ST # 748
LITTLE ROCK AR
72205-7101
US

IV. Provider business mailing address

4301 W MARKHAM ST # 748
LITTLE ROCK AR
72205-7101
US

V. Phone/Fax

Practice location:
  • Phone: 501-526-6860
  • Fax: 501-686-5212
Mailing address:
  • Phone: 501-526-6860
  • Fax: 501-686-5212

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SG0600X
TaxonomyGerontology Clinical Nurse Specialist
License NumberA003819
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: