Provider Demographics
NPI:1710143367
Name:MULLINS, KERI JANE (APRN-BC)
Entity Type:Individual
Prefix:
First Name:KERI
Middle Name:JANE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:APRN-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1366 E 1050TH AVE
Mailing Address - Street 2:
Mailing Address - City:OBLONG
Mailing Address - State:IL
Mailing Address - Zip Code:62449-2409
Mailing Address - Country:US
Mailing Address - Phone:618-592-3119
Mailing Address - Fax:618-546-2602
Practice Address - Street 1:1366 E 1050TH AVE
Practice Address - Street 2:
Practice Address - City:OBLONG
Practice Address - State:IL
Practice Address - Zip Code:62449-2409
Practice Address - Country:US
Practice Address - Phone:618-592-3119
Practice Address - Fax:618-546-2602
Is Sole Proprietor?:No
Enumeration Date:2008-08-04
Last Update Date:2020-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209007177363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily