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NPI Code Detail

MEDICARE: MALLORY NICOLE MULLINS

MEDICARE: MALLORY NICOLE MULLINS
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
1363LP2300XPrimary Care Nurse Practitioner3012151KY
2363LF0000XFamily Nurse Practitioner3012151KY

General Provider Information

NPI Number : 1992209324
Entity Type Code : Individual
Provider Name (Legal Business Name) : MALLORY NICOLE MULLINS
Provider Business Mailing Address
First Line : 3175 BEAUMONT CENTRE CIR
Second Line :
City : LEXINGTON
State : KY
Zip : 40513-1957
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 3175 BEAUMONT CENTRE CIR
Second Line :
City : LEXINGTON
State : KY
Zip : 40513-1957
Country : US
Telephone Number : 859-576-0058
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 03/21/2018
Last Update Date : 02/11/2020

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Directions to “ MALLORY NICOLE MULLINS ” Practice Location

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