Healthcare Provider Details

I. General information

NPI: 1033800271
Provider Name (Legal Business Name): JESSICA ANN MULLIS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2023
Last Update Date: 09/11/2026
Certification Date: 09/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1506 N FANT ST
ANDERSON SC
29621-4708
US

IV. Provider business mailing address

4600 MCAULEY PL STE 600
BLUE ASH OH
45242-4778
US

V. Phone/Fax

Practice location:
  • Phone: 864-260-6995
  • Fax: 864-884-9909
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27338
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: