Provider Demographics
NPI:1588368906
Name:MULLINS, BUDDYLEE PETE
Entity type:Individual
Prefix:
First Name:BUDDYLEE
Middle Name:PETE
Last Name:MULLINS
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4 POPLAR ST
Mailing Address - Street 2:
Mailing Address - City:RICHWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26261-1253
Mailing Address - Country:US
Mailing Address - Phone:681-433-2284
Mailing Address - Fax:
Practice Address - Street 1:4 POPLAR ST
Practice Address - Street 2:
Practice Address - City:RICHWOOD
Practice Address - State:WV
Practice Address - Zip Code:26261-1253
Practice Address - Country:US
Practice Address - Phone:681-433-2284
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-29
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant