Provider Demographics
NPI:1851545602
Name:MULLINS, DORRITA (ARNP)
Entity Type:Individual
Prefix:
First Name:DORRITA
Middle Name:
Last Name:MULLINS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:98 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:CLAY CITY
Mailing Address - State:KY
Mailing Address - Zip Code:40312-1314
Mailing Address - Country:US
Mailing Address - Phone:606-663-7788
Mailing Address - Fax:606-663-7785
Practice Address - Street 1:98 RIVER STREET
Practice Address - Street 2:
Practice Address - City:CLAY CITY
Practice Address - State:KY
Practice Address - Zip Code:40312
Practice Address - Country:US
Practice Address - Phone:606-663-7788
Practice Address - Fax:606-663-7785
Is Sole Proprietor?:No
Enumeration Date:2008-11-06
Last Update Date:2016-05-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPENDING363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYF1008078OtherAMERICAN ACADEMY OF NURSE PRACTITIONERS CERTIFICATION PROGRAM
KY1851545602OtherNPI NUMBER
KYMM2405935OtherKENTUCKY LICENSE FOR APRN
KY7100061910Medicaid