Provider Demographics
NPI:1255005872
Name:MULLONEY, CHRISTOPHER (APRN)
Entity Type:Individual
Prefix:
First Name:CHRISTOPHER
Middle Name:
Last Name:MULLONEY
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:85 TAYLOR AVE
Mailing Address - Street 2:
Mailing Address - City:FORT THOMAS
Mailing Address - State:KY
Mailing Address - Zip Code:41075-1387
Mailing Address - Country:US
Mailing Address - Phone:606-271-4013
Mailing Address - Fax:
Practice Address - Street 1:9245 W HIGHWAY 80
Practice Address - Street 2:
Practice Address - City:NANCY
Practice Address - State:KY
Practice Address - Zip Code:42544-8767
Practice Address - Country:US
Practice Address - Phone:606-288-0013
Practice Address - Fax:606-288-9600
Is Sole Proprietor?:No
Enumeration Date:2021-08-06
Last Update Date:2024-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3016312363LP0808X, 364SP0808X
VA0024188186363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health