Provider Demographics
NPI:1851391817
Name:MULLINIX, TIMOTHY H (CRNP)
Entity Type:Individual
Prefix:
First Name:TIMOTHY
Middle Name:H
Last Name:MULLINIX
Suffix:
Gender:M
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 639
Mailing Address - Street 2:227 HOSPITAL DRIVE
Mailing Address - City:JACKSON
Mailing Address - State:AL
Mailing Address - Zip Code:36545-0639
Mailing Address - Country:US
Mailing Address - Phone:251-246-4446
Mailing Address - Fax:251-246-5111
Practice Address - Street 1:227 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:AL
Practice Address - Zip Code:36545-2423
Practice Address - Country:US
Practice Address - Phone:251-246-4446
Practice Address - Fax:251-246-5111
Is Sole Proprietor?:No
Enumeration Date:2005-07-29
Last Update Date:2011-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-064044363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL529700760Medicaid
S72362Medicare UPIN
AL529700760Medicaid