Healthcare Provider Details

I. General information

NPI: 1780495895
Provider Name (Legal Business Name): CALIN MULLINS FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/17/2025
Last Update Date: 01/17/2025
Certification Date: 01/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 HIGHWAY 80 E
CLINTON MS
39056-5252
US

IV. Provider business mailing address

160 CHARTLEIGH CIR
CANTON MS
39046-1210
US

V. Phone/Fax

Practice location:
  • Phone: 601-910-3004
  • Fax: 601-910-3005
Mailing address:
  • Phone: 662-397-4232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907175
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: