Provider Demographics
NPI:1114322955
Name:MULLINS, MARK (FNP)
Entity Type:Individual
Prefix:
First Name:MARK
Middle Name:
Last Name:MULLINS
Suffix:
Gender:M
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 489
Mailing Address - Street 2:
Mailing Address - City:POUNDING MILL
Mailing Address - State:VA
Mailing Address - Zip Code:24637-0489
Mailing Address - Country:US
Mailing Address - Phone:276-385-1183
Mailing Address - Fax:276-345-9448
Practice Address - Street 1:13401 GOVERNOR G C PEERY HWY
Practice Address - Street 2:
Practice Address - City:POUNDING MILL
Practice Address - State:VA
Practice Address - Zip Code:24637-4010
Practice Address - Country:US
Practice Address - Phone:276-385-1183
Practice Address - Fax:276-345-9448
Is Sole Proprietor?:No
Enumeration Date:2014-10-22
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WVAPRN82732-NP-C363LF0000X
VA0024173341363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily