Provider Demographics
NPI:1417991845
Name:MULLENDORE, JENNIFER LEIGH (MD)
Entity Type:Individual
Prefix:DR
First Name:JENNIFER
Middle Name:LEIGH
Last Name:MULLENDORE
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:PO BOX 7407
Mailing Address - Street 2:ATTENTION: ACCOUNTING UNIT
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28802-7407
Mailing Address - Country:US
Mailing Address - Phone:828-250-5000
Mailing Address - Fax:828-250-6165
Practice Address - Street 1:40 COXE AVE
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28801-3308
Practice Address - Country:US
Practice Address - Phone:828-250-5000
Practice Address - Fax:828-250-6165
Is Sole Proprietor?:No
Enumeration Date:2006-06-15
Last Update Date:2013-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC200600657207Q00000X
NC2006-00657208D00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC190513OtherMEDCOST
NC5904408Medicaid
NC2055754Medicare ID - Type UnspecifiedMEDICARE
NC5904408Medicaid
NCI60041Medicare UPIN