Individual
MARTY MULLINS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA
Contact information
Practice address
210 BLACK GOLD BLVD STE 106, HAZARD, KY 41701-2620
(606) 436-0711
(606) 436-0848
Mailing address
PO BOX 959, HAZARD, KY 41702-0959
(606) 436-0711
(606) 435-1322
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
Primary
PA027
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
95000337
—
KY
Enumeration date
05/23/2005
Last updated
05/13/2021
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