Provider Demographics
NPI:1073983011
Name:MULLINS, CRYSTAL (FNP-C)
Entity Type:Individual
Prefix:
First Name:CRYSTAL
Middle Name:
Last Name:MULLINS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2402 W PIERCE ST
Mailing Address - Street 2:SUITE 6A
Mailing Address - City:CARLSBAD
Mailing Address - State:NM
Mailing Address - Zip Code:88220-3537
Mailing Address - Country:US
Mailing Address - Phone:575-689-8700
Mailing Address - Fax:575-446-4202
Practice Address - Street 1:2402 W PIERCE ST
Practice Address - Street 2:SUITE 6A
Practice Address - City:CARLSBAD
Practice Address - State:NM
Practice Address - Zip Code:88220-3537
Practice Address - Country:US
Practice Address - Phone:575-689-8700
Practice Address - Fax:575-446-4202
Is Sole Proprietor?:No
Enumeration Date:2015-10-02
Last Update Date:2020-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMCNP-02771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily