Healthcare Provider Details

I. General information

NPI: 1154257996
Provider Name (Legal Business Name): MONA RENEE MULLINS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/19/2026
Last Update Date: 06/19/2026
Certification Date: 06/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

101 WIND HAVEN DR STE 202
NICHOLASVILLE KY
40356-8036
US

IV. Provider business mailing address

126 OLD CASSIDY AVE
LEXINGTON KY
40502-2382
US

V. Phone/Fax

Practice location:
  • Phone: 859-222-3206
  • Fax: 681-339-6386
Mailing address:
  • Phone: 859-333-9727
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number255864
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: