Provider Demographics
NPI:1306008065
Name:MULLEN, ERIKA ALYSE (PA-C)
Entity Type:Individual
Prefix:
First Name:ERIKA
Middle Name:ALYSE
Last Name:MULLEN
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:ERIKA
Other - Middle Name:ALYSE
Other - Last Name:FUNDERBURG
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PA-C
Mailing Address - Street 1:5929 BALCONES DR STE 200
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78731-4280
Mailing Address - Country:US
Mailing Address - Phone:512-550-1800
Mailing Address - Fax:877-647-0202
Practice Address - Street 1:3001 KNOX ST STE 407
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75205-5594
Practice Address - Country:US
Practice Address - Phone:972-716-3922
Practice Address - Fax:877-647-0202
Is Sole Proprietor?:No
Enumeration Date:2008-06-25
Last Update Date:2023-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA005185363A00000X
HIAMD-933363A00000X
TXPA06990363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant