Provider Demographics
NPI:1326102807
Name:MULLEN, KAREN Y (MD)
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:Y
Last Name:MULLEN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13066 HWY 67
Mailing Address - Street 2:SUITES A & B
Mailing Address - City:BILOXI
Mailing Address - State:MS
Mailing Address - Zip Code:39532
Mailing Address - Country:US
Mailing Address - Phone:228-396-5022
Mailing Address - Fax:228-396-5028
Practice Address - Street 1:13066 HWY 67
Practice Address - Street 2:SUITES A & B
Practice Address - City:BILOXI
Practice Address - State:MS
Practice Address - Zip Code:39532
Practice Address - Country:US
Practice Address - Phone:228-396-5022
Practice Address - Fax:228-396-5028
Is Sole Proprietor?:No
Enumeration Date:2006-12-20
Last Update Date:2011-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMS14226207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS06103001Medicaid
F96377Medicare UPIN
MS06103001Medicaid