Provider Demographics
NPI:1457172108
Name:MULLINS, AUSTIN HUNTER (RN, AEMT, EXCPT)
Entity type:Individual
Prefix:
First Name:AUSTIN
Middle Name:HUNTER
Last Name:MULLINS
Suffix:
Gender:M
Credentials:RN, AEMT, EXCPT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4400 W STONE DR
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-1051
Mailing Address - Country:US
Mailing Address - Phone:423-247-3176
Mailing Address - Fax:
Practice Address - Street 1:135 W RAVINE RD
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3847
Practice Address - Country:US
Practice Address - Phone:423-224-4000
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-24
Last Update Date:2024-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN212388146M00000X
TN70973183700000X
TN281873163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
No146M00000XEmergency Medical Service ProvidersEmergency Medical Technician, Intermediate
No183700000XPharmacy Service ProvidersPharmacy Technician