Healthcare Provider Details

I. General information

NPI: 1932878535
Provider Name (Legal Business Name): LINDA SUE MULLINS FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/08/2021
Last Update Date: 03/10/2023
Certification Date: 03/08/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 FRONT ST W
COEBURN VA
24230-2423
US

IV. Provider business mailing address

208 FRONT ST W
COEBURN VA
24230-7019
US

V. Phone/Fax

Practice location:
  • Phone: 276-777-0380
  • Fax:
Mailing address:
  • Phone: 276-777-0380
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number30544
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024182647
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License Number0001210640
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: