Healthcare Provider Details

I. General information

NPI: 1861235145
Provider Name (Legal Business Name): CAROLINE GRACE MULLINS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/14/2024
Last Update Date: 07/14/2026
Certification Date: 07/14/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

608 NW 9TH ST STE 3206
OKLAHOMA CITY OK
73102-1049
US

IV. Provider business mailing address

608 NW 9TH ST STE 3206
OKLAHOMA CITY OK
73102-1049
US

V. Phone/Fax

Practice location:
  • Phone: 405-231-3919
  • Fax: 405-772-4484
Mailing address:
  • Phone: 405-231-3919
  • Fax: 405-772-4484

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207V00000X
TaxonomyObstetrics & Gynecology Physician
License Number1119R
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number1119R
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: