Provider Demographics
NPI:1477342673
Name:MARK MULLINS NURSE PRACTITIONER CONTRACTING SERVICES LLC
Entity type:Organization
Organization Name:MARK MULLINS NURSE PRACTITIONER CONTRACTING SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CREDENTIALIST
Authorized Official - Prefix:
Authorized Official - First Name:AL
Authorized Official - Middle Name:
Authorized Official - Last Name:BERRY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:469-915-4211
Mailing Address - Street 1:1725 BAPTIST VALLEY RD
Mailing Address - Street 2:
Mailing Address - City:CEDAR BLUFF
Mailing Address - State:VA
Mailing Address - Zip Code:24609-8642
Mailing Address - Country:US
Mailing Address - Phone:469-915-4211
Mailing Address - Fax:
Practice Address - Street 1:1921 FRONT ST
Practice Address - Street 2:
Practice Address - City:RICHLANDS
Practice Address - State:VA
Practice Address - Zip Code:24641-2350
Practice Address - Country:US
Practice Address - Phone:469-915-4211
Practice Address - Fax:276-582-0509
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARK MULLINS WELLNESS MED SPA
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2025-05-05
Last Update Date:2025-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty