Organization
HEALTHCARE FOR KIDS & TEENS, PLLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER MULLINS APRN (OWNER/PROVIDER)
(270) 692-9015
Entity
Organization
Contact information
Practice address
54 MILLER PIKE, LEBANON, KY 40033-9248
(270) 692-9015
(270) 692-9008
Mailing address
54 MILLER PIKE, LEBANON, KY 40033-9248
(270) 692-9015
(270) 692-9008
Taxonomy
Speciality
Code
Description
License number
State
208000000X
Pediatrics Physician
Primary
3004368
KY
208D00000X
General Practice Physician
3004368
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
1942307079
PROVIDER NPI
KY
01
—
3004368
APRN LICENSE
KY
05
—
78013729
—
KY
Enumeration date
02/22/2018
Last updated
02/22/2018
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