Provider Demographics
NPI:1366405250
Name:MULLINS, TAMMY (ARNP)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:
Last Name:MULLINS
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-895-8218
Mailing Address - Fax:502-895-8219
Practice Address - Street 1:3991 DUTCHMANS LANE
Practice Address - Street 2:SUITE 205
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207-4723
Practice Address - Country:US
Practice Address - Phone:502-899-6170
Practice Address - Fax:502-899-6179
Is Sole Proprietor?:No
Enumeration Date:2006-04-11
Last Update Date:2021-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71001694A363LF0000X, 363LW0102X
KY4171P363LW0102X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000633086OtherANTHEM
KY1174807Medicare PIN
KY000000633086OtherANTHEM
Q06468Medicare UPIN