Provider Demographics
NPI:1508480385
Name:MULLEN, CHRYSTEN (PA)
Entity type:Individual
Prefix:
First Name:CHRYSTEN
Middle Name:
Last Name:MULLEN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:CHRYSTEN
Other - Middle Name:SHERIDAN
Other - Last Name:MULLEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:PO BOX 68
Mailing Address - Street 2:
Mailing Address - City:POLLOCKSVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28573-0068
Mailing Address - Country:US
Mailing Address - Phone:252-635-3906
Mailing Address - Fax:252-224-0378
Practice Address - Street 1:738 NEWMAN RD
Practice Address - Street 2:
Practice Address - City:NEW BERN
Practice Address - State:NC
Practice Address - Zip Code:28562-5238
Practice Address - Country:US
Practice Address - Phone:252-634-2676
Practice Address - Fax:252-637-4479
Is Sole Proprietor?:No
Enumeration Date:2020-06-08
Last Update Date:2024-09-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MAPA7567363A00000X
NC0010-14651363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA110162194AMedicaid