Healthcare Provider Details

I. General information

NPI: 1295793388
Provider Name (Legal Business Name): BARBARA S MULLINS RN FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 05/01/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1119 LAKE ST
PENNINGTON GAP VA
24277
US

IV. Provider business mailing address

PO BOX 187
PENNINGTON GAP VA
24277
US

V. Phone/Fax

Practice location:
  • Phone: 276-546-1182
  • Fax: 276-546-5289
Mailing address:
  • Phone: 276-546-1182
  • Fax: 276-546-2497

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number0024031264
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: