Provider Demographics
NPI:1376152553
Name:MULLIS, AMY HOUSTON (CRNP)
Entity Type:Individual
Prefix:MS
First Name:AMY
Middle Name:HOUSTON
Last Name:MULLIS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:AMY
Other - Middle Name:HOUSTON
Other - Last Name:CERA
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:310 STOCK ST STE 5
Mailing Address - Street 2:
Mailing Address - City:HANOVER
Mailing Address - State:PA
Mailing Address - Zip Code:17331-2276
Mailing Address - Country:US
Mailing Address - Phone:717-316-2163
Mailing Address - Fax:570-271-6578
Practice Address - Street 1:310 STOCK ST STE 5
Practice Address - Street 2:
Practice Address - City:HANOVER
Practice Address - State:PA
Practice Address - Zip Code:17331-2276
Practice Address - Country:US
Practice Address - Phone:717-316-2163
Practice Address - Fax:570-271-6578
Is Sole Proprietor?:No
Enumeration Date:2020-07-23
Last Update Date:2023-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP022250363LG0600X, 363LP2300X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care