Provider Demographics
NPI:1235350554
Name:MULLINS, VERNON NATHANIEL (MA)
Entity Type:Individual
Prefix:MR
First Name:VERNON
Middle Name:NATHANIEL
Last Name:MULLINS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:301 STRATTON ST
Mailing Address - Street 2:
Mailing Address - City:LOGAN
Mailing Address - State:WV
Mailing Address - Zip Code:25601-3911
Mailing Address - Country:US
Mailing Address - Phone:304-752-6018
Mailing Address - Fax:304-752-4805
Practice Address - Street 1:301 STRATTON ST
Practice Address - Street 2:
Practice Address - City:LOGAN
Practice Address - State:WV
Practice Address - Zip Code:25601-3911
Practice Address - Country:US
Practice Address - Phone:304-752-6018
Practice Address - Fax:304-752-4805
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVWV-A0005231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist