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General NPI Number Information
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NPI Number | 1255887717
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Entity Type | Individual
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Provider Name | SUSANNA ELYSE MULLINAX FNP
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Gender | Female
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Dates
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Enumeration Date | 08/25/2016
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Last Update Date | 01/15/2025
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Provider Practice Location Address
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Address Line | 600 INTERSTATE 20 EAST
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City | STANTON
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State | TX
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Zip | 79782
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Country | US
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Telephone | 432-607-3200
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Fax |
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Provider Business Mailing Address
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Address Line | 1585 3RD ST
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City | FORT POLK
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State | LA
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Zip | 71459-5102
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number | AP131935
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | AP131935
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License Number State | TX
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