Provider Demographics
NPI:1770243321
Name:MULLIKIN, DIANA (FNP-C)
Entity Type:Individual
Prefix:
First Name:DIANA
Middle Name:
Last Name:MULLIKIN
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2022 CARDINAL CIR
Mailing Address - Street 2:
Mailing Address - City:ANDERSON
Mailing Address - State:SC
Mailing Address - Zip Code:29621-1504
Mailing Address - Country:US
Mailing Address - Phone:864-224-7577
Mailing Address - Fax:864-225-5165
Practice Address - Street 1:2022 CARDINAL CIR
Practice Address - Street 2:
Practice Address - City:ANDERSON
Practice Address - State:SC
Practice Address - Zip Code:29621-1504
Practice Address - Country:US
Practice Address - Phone:864-224-7577
Practice Address - Fax:864-225-5165
Is Sole Proprietor?:No
Enumeration Date:2021-12-22
Last Update Date:2023-08-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC224327163W00000X
SC27602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse