Healthcare Provider Details

I. General information

NPI: 1427878495
Provider Name (Legal Business Name): DEBORAH MCMULLAN PMHNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/15/2024
Last Update Date: 10/21/2025
Certification Date: 10/21/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 COPPERFIELD BLVD NE
CONCORD NC
28025-2433
US

IV. Provider business mailing address

4523 COLLINGHAM DR
CHARLOTTE NC
28273-0150
US

V. Phone/Fax

Practice location:
  • Phone: 980-701-9900
  • Fax: 659-242-4993
Mailing address:
  • Phone: 706-267-6812
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number5020107
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: