Provider Demographics
NPI:1497352686
Name:MULLINS, KRISTIE LYNN (CRNA)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LYNN
Last Name:MULLINS
Suffix:
Gender:F
Credentials:CRNA
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 968
Mailing Address - Street 2:
Mailing Address - City:MOREHEAD
Mailing Address - State:KY
Mailing Address - Zip Code:40351-0968
Mailing Address - Country:US
Mailing Address - Phone:866-413-9534
Mailing Address - Fax:260-407-4428
Practice Address - Street 1:222 MEDICAL CIRCLE
Practice Address - Street 2:
Practice Address - City:MOREHEAD
Practice Address - State:KY
Practice Address - Zip Code:40351-1179
Practice Address - Country:US
Practice Address - Phone:606-783-6500
Practice Address - Fax:606-783-6570
Is Sole Proprietor?:No
Enumeration Date:2020-10-01
Last Update Date:2021-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3015728367500000X
TN216058163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100719590Medicaid