Provider Demographics
NPI:1124437108
Name:MULLIN, KIMBERLEY (PA-C)
Entity type:Individual
Prefix:
First Name:KIMBERLEY
Middle Name:
Last Name:MULLIN
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:1021 BANDANA BLVD E
Mailing Address - Street 2:SUITE 100
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55108-5113
Mailing Address - Country:US
Mailing Address - Phone:651-241-9700
Mailing Address - Fax:651-241-3681
Practice Address - Street 1:1021 BANDANA BLVD E
Practice Address - Street 2:SUITE 100
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55108-5113
Practice Address - Country:US
Practice Address - Phone:651-241-9700
Practice Address - Fax:651-241-3681
Is Sole Proprietor?:No
Enumeration Date:2014-08-04
Last Update Date:2020-11-10
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN2138363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant