MEDICARE: MS. AMY HOUSTON MULLIS CRNP

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	363LG0600X	Gerontology Nurse Practitioner	SP022250	PA
2	363L00000X	Nurse Practitioner	SP022250	PA
3	363LP2300X	Primary Care Nurse Practitioner	SP022250	PA

General Provider Information

NPI Number	:	1376152553
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. AMY HOUSTON MULLIS CRNP

Provider Business Mailing Address
First Line	:	601 MEMORY LN
Second Line	:
City	:	YORK
State	:	PA
Zip	:	17402-2231
Country	:	US
Telephone Number	:	717-851-1405
Fax Number	:	717-851-6969

Provider Business Practice Location Address
First Line	:	2055 SCOTLAND AVE
Second Line	:
City	:	CHAMBERSBURG
State	:	PA
Zip	:	17201-1451
Country	:	US
Telephone Number	:	717-217-4253
Fax Number	:	717-217-2901

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

Provider Enumeration Date	:	07/23/2020
Last Update Date	:	01/19/2026

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