Provider Demographics
NPI:1568014587
Name:MULLOY, CATHY B (APRN, ANP-BC)
Entity Type:Individual
Prefix:
First Name:CATHY
Middle Name:B
Last Name:MULLOY
Suffix:
Gender:F
Credentials:APRN, ANP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3422 BEACON DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29154-8213
Mailing Address - Country:US
Mailing Address - Phone:843-367-2315
Mailing Address - Fax:
Practice Address - Street 1:3422 BEACON DR
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29154-8213
Practice Address - Country:US
Practice Address - Phone:843-367-2315
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC200731163WM0705X
SC4270363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical