Provider Demographics
NPI:1124704010
Name:MULLINS, KRISTIE LEA
Entity type:Individual
Prefix:
First Name:KRISTIE
Middle Name:LEA
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 1:43 TACKETT RD
Mailing Address - Street 2:
Mailing Address - City:VIRGIE
Mailing Address - State:KY
Mailing Address - Zip Code:41572
Mailing Address - Country:US
Mailing Address - Phone:606-639-9228
Mailing Address - Fax:
Practice Address - Street 1:330 MARS-DEBUSK PKWY
Practice Address - Street 2:
Practice Address - City:HARROGATE
Practice Address - State:TN
Practice Address - Zip Code:37752
Practice Address - Country:US
Practice Address - Phone:423-869-3611
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1149279163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse