Provider Demographics
NPI:1184448136
Name:MCMULLIN, KAELEN (AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:KAELEN
Middle Name:
Last Name:MCMULLIN
Suffix:
Gender:F
Credentials:AGPCNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:329 FAIRLAMB AVE
Mailing Address - Street 2:
Mailing Address - City:HAVERTOWN
Mailing Address - State:PA
Mailing Address - Zip Code:19083-2718
Mailing Address - Country:US
Mailing Address - Phone:570-640-7262
Mailing Address - Fax:610-576-7707
Practice Address - Street 1:1001 CHESTERBROOK BLVD
Practice Address - Street 2:
Practice Address - City:BERWYN
Practice Address - State:PA
Practice Address - Zip Code:19312-3805
Practice Address - Country:US
Practice Address - Phone:570-640-7262
Practice Address - Fax:610-576-7707
Is Sole Proprietor?:No
Enumeration Date:2024-11-14
Last Update Date:2025-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASP031007363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care