Provider Demographics
NPI:1457940827
Name:MULLINS, HOLLY KAREN
Entity Type:Individual
Prefix:
First Name:HOLLY
Middle Name:KAREN
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 1:5450 CLEARFORK MAIN ST STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76109-3514
Mailing Address - Country:US
Mailing Address - Phone:817-334-1400
Mailing Address - Fax:817-334-1410
Practice Address - Street 1:5450 CLEARFORK MAIN ST STE 300
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76109-3514
Practice Address - Country:US
Practice Address - Phone:817-334-1400
Practice Address - Fax:817-334-1410
Is Sole Proprietor?:Yes
Enumeration Date:2021-01-11
Last Update Date:2023-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1017778363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty