Provider Demographics
NPI:1639699879
Name:MULLINIX, CRISTY R (NP)
Entity Type:Individual
Prefix:
First Name:CRISTY
Middle Name:R
Last Name:MULLINIX
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:330 N WABASH
Mailing Address - Street 2:SUITE G20
Mailing Address - City:MARION
Mailing Address - State:IN
Mailing Address - Zip Code:46952-2600
Mailing Address - Country:US
Mailing Address - Phone:765-660-7616
Mailing Address - Fax:765-651-7313
Practice Address - Street 1:2651 S 800 W
Practice Address - Street 2:
Practice Address - City:SWAYZEE
Practice Address - State:IN
Practice Address - Zip Code:46986-9615
Practice Address - Country:US
Practice Address - Phone:765-660-7860
Practice Address - Fax:765-671-3505
Is Sole Proprietor?:No
Enumeration Date:2017-06-20
Last Update Date:2020-10-19
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
IN71007378A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001111096OtherANTHEM
IN300009975Medicaid