Provider Demographics
NPI:1447802137
Name:MULLEN, GENNIE MARIE (APRN-C)
Entity Type:Individual
Prefix:
First Name:GENNIE
Middle Name:MARIE
Last Name:MULLEN
Suffix:
Gender:F
Credentials:APRN-C
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 426
Mailing Address - Street 2:
Mailing Address - City:CHANUTE
Mailing Address - State:KS
Mailing Address - Zip Code:66720-0426
Mailing Address - Country:US
Mailing Address - Phone:620-244-5105
Mailing Address - Fax:620-244-5111
Practice Address - Street 1:1501 W 7TH ST STE 2
Practice Address - Street 2:
Practice Address - City:CHANUTE
Practice Address - State:KS
Practice Address - Zip Code:66720-2516
Practice Address - Country:US
Practice Address - Phone:620-243-2558
Practice Address - Fax:620-431-1192
Is Sole Proprietor?:No
Enumeration Date:2019-07-12
Last Update Date:2021-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS78874363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS78874OtherKS APRN LICENSE