Healthcare Provider Details

I. General information

NPI: 1346301785
Provider Name (Legal Business Name): CHRISTY JOY MULLIN FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/12/2006
Last Update Date: 03/11/2021
Certification Date: 03/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3790 HEDGESVILLE ROAD SUITE H
HEDGESVILLE WV
25427-6704
US

IV. Provider business mailing address

3790 HEDGESVILLE RD SUITE H
HEDGESVILLE WV
25427-6704
US

V. Phone/Fax

Practice location:
  • Phone: 304-754-7160
  • Fax: 304-754-7244
Mailing address:
  • Phone: 304-754-7160
  • Fax: 304-754-7244

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR157962
License Number StateMD
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number57766
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: