Provider Demographics
NPI:1972744779
Name:MCMULLEN, KELLY LYNNE (ATC)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:LYNNE
Last Name:MCMULLEN
Suffix:
Gender:F
Credentials:ATC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 CAMERON HALL
Mailing Address - Street 2:VIRGINIA MILITARY INSTITUTE
Mailing Address - City:LEXINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:24450
Mailing Address - Country:US
Mailing Address - Phone:540-464-7310
Mailing Address - Fax:
Practice Address - Street 1:215 CAMERON HALL
Practice Address - Street 2:VIRGINIA MILITARY INSTITUTE
Practice Address - City:LEXINGTON
Practice Address - State:VA
Practice Address - Zip Code:24450
Practice Address - Country:US
Practice Address - Phone:540-464-7310
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-03-09
Last Update Date:2009-03-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0808021342255A2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes2255A2300XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersSpecialist/TechnologistAthletic Trainer