Provider Demographics
NPI:1104172592
Name:MULLINS, LAUREN M (APRN)
Entity type:Individual
Prefix:
First Name:LAUREN
Middle Name:M
Last Name:MULLINS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 FOXGLOVE DR
Mailing Address - Street 2:SUITE D
Mailing Address - City:MT STERLING
Mailing Address - State:KY
Mailing Address - Zip Code:40353-9735
Mailing Address - Country:US
Mailing Address - Phone:859-498-3333
Mailing Address - Fax:
Practice Address - Street 1:125 FOXGLOVE DR
Practice Address - Street 2:SUITE D
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9735
Practice Address - Country:US
Practice Address - Phone:859-498-3333
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-08-03
Last Update Date:2016-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007550363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100225900Medicaid
KY3007550OtherAPRN
KYK058130Medicare PIN
KY3007550OtherAPRN
KY7100225900Medicaid
KYK058131Medicare PIN
KY00509Medicare PIN