Provider Demographics
NPI:1720477649
Name:MCMULLEN, KIERY ANN (FNP)
Entity type:Individual
Prefix:MRS
First Name:KIERY
Middle Name:ANN
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6875 AVALON AVE
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75214-3776
Mailing Address - Country:US
Mailing Address - Phone:903-278-1432
Mailing Address - Fax:
Practice Address - Street 1:901 N. GALLOWAY AVE # 107
Practice Address - Street 2:
Practice Address - City:MESQUITE
Practice Address - State:TX
Practice Address - Zip Code:75149-7418
Practice Address - Country:US
Practice Address - Phone:972-216-5152
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-01-15
Last Update Date:2019-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP127246363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily