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General NPI Number Information
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NPI Number | 1710143367
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Entity Type | Individual
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Provider Name | KERI JANE MULLINS APRN-BC
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Gender | Female
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Dates
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Enumeration Date | 08/04/2008
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Last Update Date | 08/07/2020
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Provider Practice Location Address
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Address Line | 1366 E 1050TH AVE
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City | OBLONG
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State | IL
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Zip | 62449-2409
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Country | US
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Telephone | 618-592-3119
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Fax | 618-546-2602
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Provider Business Mailing Address
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Address Line | 1366 E 1050TH AVE
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City | OBLONG
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State | IL
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Zip | 62449-2409
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Country | US
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Telephone | 618-592-3119
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Fax | 618-546-2602
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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 | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 209007177
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License Number State | IL
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