Provider Demographics
NPI:1205434719
Name:MULLEN, AARON BRADLEY (PA-C)
Entity type:Individual
Prefix:
First Name:AARON
Middle Name:BRADLEY
Last Name:MULLEN
Suffix:
Gender:M
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:PO BOX 1784
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-1784
Mailing Address - Country:US
Mailing Address - Phone:479-845-7000
Mailing Address - Fax:479-525-5961
Practice Address - Street 1:199 N 34TH ST
Practice Address - Street 2:
Practice Address - City:ROGERS
Practice Address - State:AR
Practice Address - Zip Code:72756-0304
Practice Address - Country:US
Practice Address - Phone:479-845-7000
Practice Address - Fax:479-525-5961
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant