Provider Demographics
NPI:1801987060
Name:MULLINS, LESLEY JEAN (RN, MS, CNS)
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:JEAN
Last Name:MULLINS
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Gender:F
Credentials:RN, MS, CNS
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Mailing Address - Street 1:645 S ROGERS ST
Mailing Address - Street 2:
Mailing Address - City:BLOOMINGTON
Mailing Address - State:IN
Mailing Address - Zip Code:47403-2353
Mailing Address - Country:US
Mailing Address - Phone:812-339-1691
Mailing Address - Fax:812-337-2438
Practice Address - Street 1:390 ERIE AVE
Practice Address - Street 2:
Practice Address - City:CONNERSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47331-3177
Practice Address - Country:US
Practice Address - Phone:765-825-4124
Practice Address - Fax:765-825-3649
Is Sole Proprietor?:No
Enumeration Date:2006-09-27
Last Update Date:2015-03-03
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
IN70000043A364SP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SP0808XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
S58037Medicare UPIN
IN906130QMedicare Oscar/Certification
INP00188513Medicare Oscar/Certification