Provider Demographics
NPI:1013999879
Name:MULLINAX, MERRYLEE ANN (FNP-C)
Entity type:Individual
Prefix:MISS
First Name:MERRYLEE
Middle Name:ANN
Last Name:MULLINAX
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:P.O. BOX 14611
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29610-4611
Mailing Address - Country:US
Mailing Address - Phone:864-306-0966
Mailing Address - Fax:864-306-2544
Practice Address - Street 1:3523 PELHAM RD
Practice Address - Street 2:SUITE C
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-4191
Practice Address - Country:US
Practice Address - Phone:864-306-0966
Practice Address - Fax:864-306-2544
Is Sole Proprietor?:No
Enumeration Date:2005-11-17
Last Update Date:2021-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC026671622363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0091Medicaid
SCNP0091Medicaid
S622927160Medicare ID - Type Unspecified