Provider Demographics
NPI:1306324165
Name:MULLINS, JENNIFER HELEN (LPN)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:HELEN
Last Name:MULLINS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:HELEN
Other - Last Name:CUPP
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1923 SULPHUR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37813-5654
Mailing Address - Country:US
Mailing Address - Phone:423-317-9344
Mailing Address - Fax:423-714-2355
Practice Address - Street 1:6350 W ANDREW JOHNSON HWY
Practice Address - Street 2:
Practice Address - City:TALBOTT
Practice Address - State:TN
Practice Address - Zip Code:37877-8605
Practice Address - Country:US
Practice Address - Phone:423-587-7337
Practice Address - Fax:423-586-0614
Is Sole Proprietor?:No
Enumeration Date:2018-08-03
Last Update Date:2018-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN70058164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse