Provider Demographics
NPI:1033973359
Name:MCMULLAN, RICHARD (NP)
Entity Type:Individual
Prefix:
First Name:RICHARD
Middle Name:
Last Name:MCMULLAN
Suffix:
Gender:M
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3704 BIENVILLE BLVD STE B
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5710
Mailing Address - Country:US
Mailing Address - Phone:228-872-4040
Mailing Address - Fax:
Practice Address - Street 1:15190 COMMUNITY RD STE 260
Practice Address - Street 2:
Practice Address - City:GULFPORT
Practice Address - State:MS
Practice Address - Zip Code:39503-3471
Practice Address - Country:US
Practice Address - Phone:228-575-8020
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-07
Last Update Date:2024-02-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS906506364SA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2100XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAcute Care