Provider Demographics
NPI:1487369328
Name:MULLINS, KAYLEIGH KEMMY (NP)
Entity type:Individual
Prefix:
First Name:KAYLEIGH
Middle Name:KEMMY
Last Name:MULLINS
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:KAYLEIGH
Other - Middle Name:NOELLE
Other - Last Name:KEMMY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:300 E MCBEE AVE FL 4
Mailing Address - Street 2:
Mailing Address - City:GREENVILLE
Mailing Address - State:SC
Mailing Address - Zip Code:29601-2842
Mailing Address - Country:US
Mailing Address - Phone:864-522-8603
Mailing Address - Fax:
Practice Address - Street 1:200 PATEWOOD DR STE B350
Practice Address - Street 2:
Practice Address - City:GREENVILLE
Practice Address - State:SC
Practice Address - Zip Code:29615-6337
Practice Address - Country:US
Practice Address - Phone:864-454-4500
Practice Address - Fax:864-454-4505
Is Sole Proprietor?:No
Enumeration Date:2023-01-16
Last Update Date:2023-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC27982363LC0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LC0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerCritical Care Medicine