Provider Demographics
NPI:1306866330
Name:MULLINS, DAVID CELDON (CRNA)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:CELDON
Last Name:MULLINS
Suffix:
Gender:M
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6140 S MEMORIAL DR
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-1933
Mailing Address - Country:US
Mailing Address - Phone:918-252-2020
Mailing Address - Fax:
Practice Address - Street 1:6140 S MEMORIAL DR
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1933
Practice Address - Country:US
Practice Address - Phone:918-252-2020
Practice Address - Fax:918-307-1983
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-20
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK033614367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKP01052454OtherRR MEDICARE
OK010672601002OtherBCBSOK
OK100784710AMedicaid
OK010672601002OtherBCBSOK
OK363741ZJBTMedicare PIN
OKOKAAA3641Medicare PIN