Individual
KELLY LOUISE MULLEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
605 N WALNUT ST, NORTH MANCHESTER, IN 46962-1857
(260) 982-1994
(260) 479-2936
Mailing address
6920 POINTE INVERNESS WAY STE 200, FORT WAYNE, IN 46804-7934
(260) 479-3513
(260) 479-3520
Taxonomy
Speciality
Code
Description
License number
State
207Q00000X
Family Medicine Physician
Primary
11019604A
IN
Other
Enumeration date
06/26/2017
Last updated
10/27/2020
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