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Individual

MRS. TRACEY MULLINS

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
NP

Contact information

Practice address
1401 RIVER RD, GREENWOOD, MS 38930-4030
(662) 459-7000
(662) 459-1147
Mailing address
PO BOX 369, VAIDEN, MS 39176-0369
(662) 464-5470

Taxonomy

Speciality
Code
Description
License number
State
363L00000X
Nurse Practitioner
Primary
R681857
MS

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
00118843
MS
Enumeration date
03/23/2006
Last updated
07/25/2011
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