Provider Demographics
NPI:1912782467
Name:MULLINS, HALEY FAITH
Entity Type:Individual
Prefix:
First Name:HALEY
Middle Name:FAITH
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 1:1711 STAPLES ST
Mailing Address - Street 2:
Mailing Address - City:RADFORD
Mailing Address - State:VA
Mailing Address - Zip Code:24141-3335
Mailing Address - Country:US
Mailing Address - Phone:276-439-9153
Mailing Address - Fax:
Practice Address - Street 1:1711 STAPLES ST
Practice Address - Street 2:
Practice Address - City:RADFORD
Practice Address - State:VA
Practice Address - Zip Code:24141-3335
Practice Address - Country:US
Practice Address - Phone:276-439-9153
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant