Provider Demographics
NPI:1821069964
Name:MULLINAX, DEBORAH LYNN (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:DEBORAH
Middle Name:LYNN
Last Name:MULLINAX
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 1:2335 PAPAGO DR
Mailing Address - Street 2:
Mailing Address - City:SHERIDAN
Mailing Address - State:WY
Mailing Address - Zip Code:82801-5835
Mailing Address - Country:US
Mailing Address - Phone:307-674-6093
Mailing Address - Fax:
Practice Address - Street 1:916 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:SHERIDAN
Practice Address - State:WY
Practice Address - Zip Code:82801-2708
Practice Address - Country:US
Practice Address - Phone:307-672-6451
Practice Address - Fax:307-672-1704
Is Sole Proprietor?:No
Enumeration Date:2006-01-27
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY344363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
WY00941001OtherBCBS GROUP
NE830245718-13Medicaid
SD7705130Medicaid
MT000405665Medicaid
WY313672OtherBCBS INDIV
WY100048900Medicaid