MEDICARE: TERIA MULLIN APN, CRNA, FNP-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	363LF0000X	Family Nurse Practitioner	1092258	TX
2	363LF0000X	Family Nurse Practitioner	209033408	IL
3	163W00000X	Registered Nurse	041.337943	IL
4	367500000X	Certified Registered Nurse Anesthetist	209007935	IL
5	367500000X	Certified Registered Nurse Anesthetist	1092258	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1821322421
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TERIA MULLIN APN, CRNA, FNP-C

Provider Business Mailing Address
First Line	:	5606 SMU BLVD
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75206-5018
Country	:	US
Telephone Number	:	972-779-0007
Fax Number	:	513-987-9512

Provider Business Practice Location Address
First Line	:	2540 N GALLOWAY AVE STE 303
Second Line	:
City	:	MESQUITE
State	:	TX
Zip	:	75150-4814
Country	:	US
Telephone Number	:	972-779-0007
Fax Number	:	513-987-9512

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

Provider Enumeration Date	:	09/29/2009
Last Update Date	:	04/09/2026

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