Provider Demographics
NPI:1093535437
Name:MULLINIX, KRISTA (EDS)
Entity type:Individual
Prefix:MRS
First Name:KRISTA
Middle Name:
Last Name:MULLINIX
Suffix:
Gender:F
Credentials:EDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13485 CUMBERLAND RD
Mailing Address - Street 2:
Mailing Address - City:FISHERS
Mailing Address - State:IN
Mailing Address - Zip Code:46038-3602
Mailing Address - Country:US
Mailing Address - Phone:317-594-4100
Mailing Address - Fax:
Practice Address - Street 1:13485 CUMBERLAND RD
Practice Address - Street 2:
Practice Address - City:FISHERS
Practice Address - State:IN
Practice Address - Zip Code:46038-3602
Practice Address - Country:US
Practice Address - Phone:317-594-4100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-11
Last Update Date:2024-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN1171691103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool