Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | AP126263 | TX |
NPI | 1003216755 |
---|---|
Provider Name | Amber Mullins |
First Address | Grand Prairie, TX 75052-3203 |
Second Address | Grand Prairie, TX 75052 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 31/08/2014 |
Last Update Date | 29/04/2019 |