Provider Demographics
NPI:1760192868
Name:MULLINS, STEVIE-MARIE ANN (PA-C)
Entity Type:Individual
Prefix:
First Name:STEVIE-MARIE
Middle Name:ANN
Last Name:MULLINS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 W LEGACY CROSSING BLVD STE 200
Mailing Address - Street 2:
Mailing Address - City:CENTERVILLE
Mailing Address - State:UT
Mailing Address - Zip Code:84014-5560
Mailing Address - Country:US
Mailing Address - Phone:801-298-3802
Mailing Address - Fax:
Practice Address - Street 1:1222 W LEGACY CROSSING BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-5560
Practice Address - Country:US
Practice Address - Phone:801-298-3802
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-29
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
No363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical