Basic Information
| Provider Information | |||||||||
| NPI: | 1720508971 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MULLINS | ||||||||
| FirstName: | GWENDOLIN | ||||||||
| MiddleName: | B | ||||||||
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| Credential: | FNP | ||||||||
| OtherOrganizationName: | |||||||||
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| OtherLastName: | SHAFFER | ||||||||
| OtherFirstName: | GWENDOLIN | ||||||||
| OtherMiddleName: | B | ||||||||
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| OtherCredential: | |||||||||
| OtherLastNameType: | 1 | ||||||||
| Mailing Information | |||||||||
| Address1: | 333 COMMERCE ST STE 700 | ||||||||
| Address2: | |||||||||
| City: | NASHVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 372011835 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6156272293 | ||||||||
| FaxNumber: | 8884942588 | ||||||||
| Practice Location | |||||||||
| Address1: | 5201 KINGSTON PIKE STE 6 | ||||||||
| Address2: | |||||||||
| City: | KNOXVILLE | ||||||||
| State: | TN | ||||||||
| PostalCode: | 379195011 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 8659786182 | ||||||||
| FaxNumber: | 8557375542 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/20/2017 | ||||||||
| LastUpdateDate: | 07/21/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163W00000X | 120275 | TN | N | Nursing Service Providers | Registered Nurse | 363LF0000X | 22722 | TN | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.