Provider Demographics
NPI:1275309551
Name:MCMULLAN, MARK HALLIE (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:MARK
Middle Name:HALLIE
Last Name:MCMULLAN
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:562 W MAIN ST
Mailing Address - Street 2:
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38506-5382
Mailing Address - Country:US
Mailing Address - Phone:931-854-9601
Mailing Address - Fax:931-854-9605
Practice Address - Street 1:562 W MAIN ST
Practice Address - Street 2:
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38506-5382
Practice Address - Country:US
Practice Address - Phone:931-854-9601
Practice Address - Fax:931-854-9605
Is Sole Proprietor?:No
Enumeration Date:2023-11-28
Last Update Date:2023-12-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA95027052363L00000X
TN35187363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner