Healthcare Provider Details

I. General information

NPI: 1093727240
Provider Name (Legal Business Name): LAURELIN MULLINS RN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/13/2006
Last Update Date: 08/15/2023
Certification Date: 08/15/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 PARK BEND DR BLDG 2-204
AUSTIN TX
78758-5584
US

IV. Provider business mailing address

4616 W HOWARD LN
AUSTIN TX
78731
US

V. Phone/Fax

Practice location:
  • Phone: 855-481-8375
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number643821
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: