Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0401X | Family Doctor - Addiction Medicine | 0024177387 | VA |
N | 207QA0505X | Family Doctor - Adult Medicine | 0024177387 | VA |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3013320 | KY |
NPI | 1598226045 |
---|---|
Provider Name | Joshua Adam Mullins |
First Address | Pikeville, KY 41502-0432 |
Second Address | Pikeville, KY 41501-1689 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/03/2019 |
Last Update Date | 08/07/2021 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0024177387 | LICENSED NURSE PRACTITIONER (01) | VA |