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General NPI Number Information
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NPI Number | 1699146100
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Entity Type | Individual
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Provider Name | JASON WESLEY MULLINS PA-C
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Gender | Male
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Dates
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Enumeration Date | 10/09/2015
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Last Update Date | 02/11/2020
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Provider Practice Location Address
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Address Line | 4004 LOUISA ROAD
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City | CATLETTSBURG
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State | KY
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Zip | 41129-1091
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Country | US
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Telephone | 606-739-6095
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Fax | 606-739-8252
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Provider Business Mailing Address
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Address Line | P. O. BOX 1595
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City | ASHLAND
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State | KY
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Zip | 41105-1595
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Country | US
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Telephone | 606-408-6200
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Fax | 606-408-6612
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA2046
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License Number State | KY
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