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General NPI Number Information
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NPI Number | 1982056198
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Entity Type | Individual
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Provider Name | KELLI MULLEN OD
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Gender | Female
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Dates
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Enumeration Date | 07/12/2016
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Last Update Date | 12/01/2025
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Provider Practice Location Address
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Address Line | 303 J H PHILLIPS LN
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City | NEW ALBANY
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State | MS
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Zip | 38652-7012
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Country | US
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Telephone | 662-539-7801
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Fax | 662-539-7881
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Provider Business Mailing Address
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Address Line | 41 COUNTY ROAD 229
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City | BRUCE
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State | MS
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Zip | 38915-9462
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Country | US
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Telephone | 662-983-9205
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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 | 152W00000X
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Taxonomy Name | Optometrist
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License Number | 939
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License Number State | MS
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