Healthcare Provider Details

I. General information

NPI: 1659400927
Provider Name (Legal Business Name): KATHRYN MULLEN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/05/2007
Last Update Date: 05/11/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1017 CARDINAL DR
LOUISVILLE KY
40213-1367
US

IV. Provider business mailing address

1017 CARDINAL DR
LOUISVILLE KY
40213-1367
US

V. Phone/Fax

Practice location:
  • Phone: 502-773-3097
  • Fax: 502-637-2124
Mailing address:
  • Phone: 502-773-3097
  • Fax: 502-637-2124

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174400000X
TaxonomySpecialist
License Number
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code222Q00000X
TaxonomyDevelopmental Therapist
License Number200172532
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: