Provider Demographics
NPI:1487633038
Name:MULLINIX, RANDY (PA-C)
Entity Type:Individual
Prefix:MR
First Name:RANDY
Middle Name:
Last Name:MULLINIX
Suffix:
Gender:M
Credentials:PA-C
Other - Prefix:
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Other - Middle Name:
Other - Last Name:
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Mailing Address - Street 1:510 BUTLER AVE
Mailing Address - Street 2:MARTINSBURG VA MED CENTER/ WARD 6A
Mailing Address - City:MARTINSBURG
Mailing Address - State:WV
Mailing Address - Zip Code:25405-9990
Mailing Address - Country:US
Mailing Address - Phone:304-263-0811
Mailing Address - Fax:304-264-3989
Practice Address - Street 1:510 BUTLER AVE
Practice Address - Street 2:MENTAL HEALTH SERVICE
Practice Address - City:MARTINSBURG
Practice Address - State:WV
Practice Address - Zip Code:25401-9990
Practice Address - Country:US
Practice Address - Phone:304-263-0811
Practice Address - Fax:304-264-3989
Is Sole Proprietor?:No
Enumeration Date:2006-01-12
Last Update Date:2007-07-11
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
WV00201363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant