Provider Demographics
NPI:1336855758
Name:MULLEN, JENNIFER YOOJIN (AGPCNP-BC)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:YOOJIN
Last Name:MULLEN
Suffix:
Gender:F
Credentials:AGPCNP-BC
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 751803
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28275-1803
Mailing Address - Country:US
Mailing Address - Phone:336-992-1351
Mailing Address - Fax:336-992-1361
Practice Address - Street 1:500 PINEVIEW DR STE 101
Practice Address - Street 2:
Practice Address - City:KERNERSVILLE
Practice Address - State:NC
Practice Address - Zip Code:27284-3813
Practice Address - Country:US
Practice Address - Phone:336-992-1351
Practice Address - Fax:336-992-1361
Is Sole Proprietor?:No
Enumeration Date:2023-01-30
Last Update Date:2024-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC295832163W00000X
NC5017606363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No163W00000XNursing Service ProvidersRegistered Nurse