Provider Demographics
NPI:1295483071
Name:MCMULLEN, ANNA (PMHNP)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:KATHERINE
Other - Last Name:LINK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PMHNP
Mailing Address - Street 1:12293 SAVANNAH CIR
Mailing Address - Street 2:
Mailing Address - City:OCEAN SPRINGS
Mailing Address - State:MS
Mailing Address - Zip Code:39564-5678
Mailing Address - Country:US
Mailing Address - Phone:443-834-9582
Mailing Address - Fax:
Practice Address - Street 1:12293 SAVANNAH CIR
Practice Address - Street 2:
Practice Address - City:OCEAN SPRINGS
Practice Address - State:MS
Practice Address - Zip Code:39564-5678
Practice Address - Country:US
Practice Address - Phone:443-834-9582
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-11
Last Update Date:2024-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11018549363LP0808X
ID77990363LP0808X
NYF404465-01363LP0808X
IAG177146363LP0808X
KS53-82767-112363LP0808X
WAAP61282990363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health