Provider Demographics
NPI:1730746058
Name:MULLEN, KALIE IRENE (CPNP)
Entity type:Individual
Prefix:
First Name:KALIE
Middle Name:IRENE
Last Name:MULLEN
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:KALEI
Other - Middle Name:IRENE
Other - Last Name:SKERIK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPNP
Mailing Address - Street 1:PO BOX 733784
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75373-3784
Mailing Address - Country:US
Mailing Address - Phone:682-885-6483
Mailing Address - Fax:682-885-3113
Practice Address - Street 1:2300 SH-114 STE. 300
Practice Address - Street 2:
Practice Address - City:TROPHY CLUB
Practice Address - State:TX
Practice Address - Zip Code:76262
Practice Address - Country:US
Practice Address - Phone:817-347-8100
Practice Address - Fax:817-349-8099
Is Sole Proprietor?:No
Enumeration Date:2019-05-22
Last Update Date:2023-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP142441363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care