Provider Demographics
NPI:1144469180
Name:MULLIN, KATHY ANN (FNP)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:ANN
Last Name:MULLIN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6626 E. 75TH STREET
Mailing Address - Street 2:SUITE 500
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46250-2890
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:333 E COUNTY LINE RD
Practice Address - Street 2:SUITE B
Practice Address - City:GREENWOOD
Practice Address - State:IN
Practice Address - Zip Code:46143-1080
Practice Address - Country:US
Practice Address - Phone:317-621-1247
Practice Address - Fax:317-497-6334
Is Sole Proprietor?:No
Enumeration Date:2009-02-16
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71002837A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200941670Medicaid
INP01157059OtherRR MEDICARE PTAN
INM400038392Medicare PIN
INM400038413Medicare PIN
IN265900HMedicare PIN
INP01157059OtherRR MEDICARE PTAN
INM400038384Medicare PIN
INM400038394Medicare PIN
INM400038411Medicare PIN
INM400055638Medicare PIN