Provider Demographics
NPI:1922071570
Name:MULLET, STACY K (NP)
Entity Type:Individual
Prefix:
First Name:STACY
Middle Name:K
Last Name:MULLET
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:STACY
Other - Middle Name:K
Other - Last Name:URBAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:13220 ROSEDALE HILL AVE
Mailing Address - Street 2:
Mailing Address - City:HUNTERSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28078-0361
Mailing Address - Country:US
Mailing Address - Phone:704-766-0320
Mailing Address - Fax:704-766-0407
Practice Address - Street 1:13220 ROSEDALE HILL AVE
Practice Address - Street 2:
Practice Address - City:HUNTERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:28078-0361
Practice Address - Country:US
Practice Address - Phone:704-766-0320
Practice Address - Fax:704-766-0407
Is Sole Proprietor?:No
Enumeration Date:2006-02-13
Last Update Date:2012-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC5001116363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
NCQ62193Medicare UPIN
NC2592559AMedicare PIN