Provider Demographics
NPI:1013357144
Name:MULLINS, SHERRY MICHELE (PA-C)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:MICHELE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:603 E AMBER ST STE 101
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78221-2456
Mailing Address - Country:US
Mailing Address - Phone:210-610-7283
Mailing Address - Fax:830-331-8718
Practice Address - Street 1:603 E AMBER ST STE 101
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78221-2456
Practice Address - Country:US
Practice Address - Phone:210-610-7283
Practice Address - Fax:830-331-8718
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-03
Last Update Date:2021-11-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8786NNOtherBC PIN
TX397498ZGW9Medicare PIN