Basic Information
| Provider Information | |||||||||
| NPI: | 1215307459 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MULLINS | ||||||||
| FirstName: | MEGHAN | ||||||||
| MiddleName: | M | ||||||||
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| Credential: | MMS, PA-C | ||||||||
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| Mailing Information | |||||||||
| Address1: | 215 E SPRINGBROOK DR | ||||||||
| Address2: | |||||||||
| City: | JOHNSON CITY | ||||||||
| State: | TN | ||||||||
| PostalCode: | 376011761 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4232828070 | ||||||||
| FaxNumber: | 4232828550 | ||||||||
| Practice Location | |||||||||
| Address1: | 1020 TERRACE DR | ||||||||
| Address2: | SUITE 200 | ||||||||
| City: | MARION | ||||||||
| State: | VA | ||||||||
| PostalCode: | 243544392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2767837167 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/30/2015 | ||||||||
| LastUpdateDate: | 03/09/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/09/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363A00000X | 3498 | TN | N | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant | 363A00000X | 0110-005086 | VA | Y | Physician Assistants & Advanced Practice Nursing Providers | Physician Assistant |
No ID Information.