Provider Demographics
NPI:1336195544
Name:MULLINS, PEGGY H (MSW)
Entity Type:Individual
Prefix:MRS
First Name:PEGGY
Middle Name:H
Last Name:MULLINS
Suffix:
Gender:F
Credentials:MSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1861 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:HOPKINSVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42240-4476
Mailing Address - Country:US
Mailing Address - Phone:270-881-1062
Mailing Address - Fax:270-887-0785
Practice Address - Street 1:1609 S MAIN ST
Practice Address - Street 2:
Practice Address - City:HOPKINSVILLE
Practice Address - State:KY
Practice Address - Zip Code:42240-1970
Practice Address - Country:US
Practice Address - Phone:270-881-1062
Practice Address - Fax:270-887-0785
Is Sole Proprietor?:No
Enumeration Date:2006-05-26
Last Update Date:2007-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYKY03104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYR36780Medicare UPIN
KY0713401Medicare PIN