Provider Demographics
NPI:1316528367
Name:MULLEN, KALEIGH ANN (DO)
Entity type:Individual
Prefix:
First Name:KALEIGH
Middle Name:ANN
Last Name:MULLEN
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:786 D ST
Mailing Address - Street 2:
Mailing Address - City:JBER
Mailing Address - State:AK
Mailing Address - Zip Code:99505-4000
Mailing Address - Country:US
Mailing Address - Phone:580-384-3807
Mailing Address - Fax:
Practice Address - Street 1:786 D ST
Practice Address - Street 2:
Practice Address - City:JBER
Practice Address - State:AK
Practice Address - Zip Code:99505-4000
Practice Address - Country:US
Practice Address - Phone:803-843-8075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-20
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GA94678207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine