Healthcare Provider Details

I. General information

NPI: 1124704010
Provider Name (Legal Business Name): KRISTIE LEA MULLINS CRNA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 01/09/2026
Certification Date: 01/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

911 BYPASS RD
PIKEVILLE KY
41501-1602
US

IV. Provider business mailing address

43 TACKETT RD
VIRGIE KY
41572-8499
US

V. Phone/Fax

Practice location:
  • Phone: 606-430-2500
  • Fax:
Mailing address:
  • Phone: 606-639-9228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number1149279
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License Number4051233
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: