Provider Demographics
NPI:1063381754
Name:MULLIN, JADYN SHAY
Entity type:Individual
Prefix:
First Name:JADYN
Middle Name:SHAY
Last Name:MULLIN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JADYN
Other - Middle Name:SHAY
Other - Last Name:LENARD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1854 E PORTER ST
Mailing Address - Street 2:
Mailing Address - City:KUNA
Mailing Address - State:ID
Mailing Address - Zip Code:83634-2551
Mailing Address - Country:US
Mailing Address - Phone:208-996-9064
Mailing Address - Fax:
Practice Address - Street 1:2537 W STATE ST STE 200
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83702-2200
Practice Address - Country:US
Practice Address - Phone:208-336-0895
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-11-01
Last Update Date:2025-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program