Provider Demographics
NPI:1093507675
Name:MULLINS, ALLYSSA SHANTEA
Entity type:Individual
Prefix:
First Name:ALLYSSA
Middle Name:SHANTEA
Last Name:MULLINS
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:510 BEE BRANCH RD
Mailing Address - Street 2:
Mailing Address - City:MOHAWK
Mailing Address - State:WV
Mailing Address - Zip Code:24862-7052
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:510 BEE BRANCH RD
Practice Address - Street 2:
Practice Address - City:MOHAWK
Practice Address - State:WV
Practice Address - Zip Code:24862-7052
Practice Address - Country:US
Practice Address - Phone:276-312-0260
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-05-20
Last Update Date:2025-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide