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General NPI Number Information
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NPI Number | 1699181917
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Entity Type | Individual
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Provider Name | JESSICA HOPE MULLENIX AGNP
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Gender | Female
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Dates
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Enumeration Date | 07/08/2014
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Last Update Date | 07/08/2014
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Provider Practice Location Address
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Address Line | 4414 LAKE BOONE TRL SUITE 402
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City | RALEIGH
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State | NC
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Zip | 27607-7513
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Country | US
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Telephone | 919-784-5600
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Fax | 919-784-5601
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Provider Business Mailing Address
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Address Line | 4414 LAKE BOONE TRL SUITE 402
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City | RALEIGH
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State | NC
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Zip | 27607-7513
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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 | 5006953
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License Number State | NC
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