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General NPI Number Information
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NPI Number | 1356864722
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Entity Type | Individual
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Provider Name | CANDACE L MULLENS MS, PA-C
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Gender | Female
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Dates
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Enumeration Date | 07/18/2017
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Last Update Date | 12/13/2025
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Provider Practice Location Address
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Address Line | 5323 HARRY HINES BLVD STOP 7200
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City | DALLAS
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State | TX
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Zip | 75390-7200
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Country | US
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Telephone | 214-648-3111
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Fax |
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Provider Business Mailing Address
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Address Line | 215 OLD HIGHWAY 1187
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City | BURLESON
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State | TX
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Zip | 76028-0281
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Country | US
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Telephone | 817-926-2663
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Fax | 817-293-8860
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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 | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | PA12461
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License Number State | TX
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Taxonomy #2
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Taxonomy Code | 363AS0400X
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Taxonomy Name | Surgical Physician Assistant
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License Number | PA12461
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License Number State | TX
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Taxonomy #3
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 54792
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License Number State | CA
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