MEDICARE: JASON WESLEY MULLINS PA-C

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	363AM0700X	Medical Physician Assistant	PA2046	KY

General Provider Information

NPI Number	:	1699146100
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JASON WESLEY MULLINS PA-C

Provider Business Mailing Address
First Line	:	P. O. BOX 1595
Second Line	:
City	:	ASHLAND
State	:	KY
Zip	:	41105-1595
Country	:	US
Telephone Number	:	606-408-6200
Fax Number	:	606-408-6612

Provider Business Practice Location Address
First Line	:	4004 LOUISA ROAD
Second Line	:
City	:	CATLETTSBURG
State	:	KY
Zip	:	41129-1091
Country	:	US
Telephone Number	:	606-739-6095
Fax Number	:	606-739-8252

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

Provider Enumeration Date	:	10/09/2015
Last Update Date	:	02/11/2020

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