Provider Demographics
NPI:1558980870
Name:MULLINS, JESSICA (DPM)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:
Last Name:MULLINS
Suffix:
Gender:F
Credentials:DPM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:331 LAIDLEY ST STE 504
Mailing Address - Street 2:
Mailing Address - City:CHARLESTON
Mailing Address - State:WV
Mailing Address - Zip Code:25301-1682
Mailing Address - Country:US
Mailing Address - Phone:304-347-6630
Mailing Address - Fax:
Practice Address - Street 1:331 LAIDLEY ST STE 504
Practice Address - Street 2:
Practice Address - City:CHARLESTON
Practice Address - State:WV
Practice Address - Zip Code:25301-1682
Practice Address - Country:US
Practice Address - Phone:304-347-6630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-04-16
Last Update Date:2024-06-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV10505213E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes213E00000XPodiatric Medicine & Surgery Service ProvidersPodiatrist