Individual
JENNY MULLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
NP
Contact information
Practice address
253 SAGAMORE PKWY W, WEST LAFAYETTE, IN 47906
(765) 448-8000
Mailing address
1200 W WHITE RIVER BLVD, MUNCIE, IN 47303-4988
(877) 668-5621
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
71008297B
IN
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
PENDING
ANTHEM PROVIDER NUMBER
IN
05
—
PENDING
—
IN
Enumeration date
07/10/2018
Last updated
06/09/2021
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