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General NPI Number Information
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NPI Number | 1750161659
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Entity Type | Individual
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Provider Name | SAMANTHA LEE MULLINS
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Gender | Female
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Dates
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Enumeration Date | 09/29/2023
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Last Update Date | 10/21/2023
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Provider Practice Location Address
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Address Line | 300 56TH ST SE
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City | CHARLESTON
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State | WV
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Zip | 25304-2361
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Country | US
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Telephone | 304-301-3975
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Fax |
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Provider Business Mailing Address
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Address Line | 1402 2ND AVE W
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City | MONTGOMERY
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State | WV
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Zip | 25136-2025
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Country | US
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Telephone | 304-989-8344
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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 | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 117767
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License Number State | WV
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