MEDICARE: DR. KRISTIE LEA MULLINS CRNA

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	163W00000X	Registered Nurse	1149279	KY
2	367500000X	Certified Registered Nurse Anesthetist	4051233	KY

General Provider Information

NPI Number	:	1124704010
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. KRISTIE LEA MULLINS CRNA

Provider Business Mailing Address
First Line	:	PO BOX 432
Second Line	:
City	:	PIKEVILLE
State	:	KY
Zip	:	41502-0432
Country	:	US
Telephone Number	:	606-430-3500
Fax Number	:	606-218-4697

Provider Business Practice Location Address
First Line	:	911 BYPASS RD BLDG A
Second Line	:
City	:	PIKEVILLE
State	:	KY
Zip	:	41501-1602
Country	:	US
Telephone Number	:	606-430-3500
Fax Number	:	606-218-4697

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	03/02/2026

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