Provider Demographics
NPI:1427368943
Name:MULLINS, DAVID L (ACNP-BC)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:MULLINS
Suffix:
Gender:M
Credentials:ACNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2414 CHAMBLISS AVE NW
Mailing Address - Street 2:
Mailing Address - City:CLEVELAND
Mailing Address - State:TN
Mailing Address - Zip Code:37311-3879
Mailing Address - Country:US
Mailing Address - Phone:423-250-5864
Mailing Address - Fax:423-250-5412
Practice Address - Street 1:2414 CHAMBLISS AVE NW
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:TN
Practice Address - Zip Code:37311-3879
Practice Address - Country:US
Practice Address - Phone:423-250-5864
Practice Address - Fax:423-250-5412
Is Sole Proprietor?:No
Enumeration Date:2010-10-18
Last Update Date:2024-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN15251363L00000X
GARN166076363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ006937Medicaid