Provider Demographics
NPI:1194199653
Name:MULLINS, DEVON (RN, CLC)
Entity type:Individual
Prefix:
First Name:DEVON
Middle Name:
Last Name:MULLINS
Suffix:
Gender:F
Credentials:RN, CLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19501 S 4210 RD
Mailing Address - Street 2:
Mailing Address - City:CLAREMORE
Mailing Address - State:OK
Mailing Address - Zip Code:74019-4241
Mailing Address - Country:US
Mailing Address - Phone:918-530-7789
Mailing Address - Fax:
Practice Address - Street 1:2626 E 21ST ST STE 6
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74114-1719
Practice Address - Country:US
Practice Address - Phone:918-233-8328
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-11-20
Last Update Date:2022-04-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0133635163WL0100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WL0100XNursing Service ProvidersRegistered NurseLactation Consultant