Provider Demographics
NPI:1982056198
Name:MULLEN, KELLI (OD)
Entity type:Individual
Prefix:
First Name:KELLI
Middle Name:
Last Name:MULLEN
Suffix:
Gender:F
Credentials:OD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:41 COUNTY ROAD 229
Mailing Address - Street 2:
Mailing Address - City:BRUCE
Mailing Address - State:MS
Mailing Address - Zip Code:38915-9462
Mailing Address - Country:US
Mailing Address - Phone:662-983-9205
Mailing Address - Fax:
Practice Address - Street 1:303 J H PHILLIPS LN
Practice Address - Street 2:
Practice Address - City:NEW ALBANY
Practice Address - State:MS
Practice Address - Zip Code:38652-7012
Practice Address - Country:US
Practice Address - Phone:662-539-7801
Practice Address - Fax:662-539-7881
Is Sole Proprietor?:No
Enumeration Date:2016-07-12
Last Update Date:2025-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS939152W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes152W00000XEye and Vision Services ProvidersOptometrist