Provider Demographics
NPI:1235388083
Name:MULLINS, NICOLE L (CNP)
Entity Type:Individual
Prefix:
First Name:NICOLE
Middle Name:L
Last Name:MULLINS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:L
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:CNP
Mailing Address - Street 1:2123 AUBURN AVE
Mailing Address - Street 2:STE 401
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45219-2906
Mailing Address - Country:US
Mailing Address - Phone:513-241-5489
Mailing Address - Fax:513-241-5490
Practice Address - Street 1:2123 AUBURN AVE
Practice Address - Street 2:STE 401
Practice Address - City:CINCINNATI
Practice Address - State:OH
Practice Address - Zip Code:45219-2906
Practice Address - Country:US
Practice Address - Phone:513-241-5489
Practice Address - Fax:513-241-5490
Is Sole Proprietor?:No
Enumeration Date:2008-09-17
Last Update Date:2020-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA1026NP363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100062390Medicaid
OH2957895Medicaid
OHH231640Medicare UPIN