Provider Demographics
NPI:1245851708
Name:MULLINS, KRYSTA LIANE
Entity type:Individual
Prefix:
First Name:KRYSTA
Middle Name:LIANE
Last Name:MULLINS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1121 UNDERWOOD RD
Mailing Address - Street 2:
Mailing Address - City:ALEDO
Mailing Address - State:TX
Mailing Address - Zip Code:76008-2458
Mailing Address - Country:US
Mailing Address - Phone:682-412-5455
Mailing Address - Fax:
Practice Address - Street 1:1121 UNDERWOOD RD
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-2458
Practice Address - Country:US
Practice Address - Phone:682-412-5455
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-06
Last Update Date:2020-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX353241164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse