Provider Demographics
NPI:1437704921
Name:MULLINS, DANIEL LEE (PA-C)
Entity Type:Individual
Prefix:
First Name:DANIEL
Middle Name:LEE
Last Name:MULLINS
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1825 AIRPORT EXCHANGE BLVD STE 100
Mailing Address - Street 2:
Mailing Address - City:ERLANGER
Mailing Address - State:KY
Mailing Address - Zip Code:41018-3900
Mailing Address - Country:US
Mailing Address - Phone:859-647-6228
Mailing Address - Fax:859-372-6350
Practice Address - Street 1:1825 AIRPORT EXCHANGE BLVD STE 100
Practice Address - Street 2:
Practice Address - City:ERLANGER
Practice Address - State:KY
Practice Address - Zip Code:41018-3900
Practice Address - Country:US
Practice Address - Phone:859-647-6228
Practice Address - Fax:859-372-6350
Is Sole Proprietor?:Yes
Enumeration Date:2019-08-02
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1155366363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical