Individual provider Active NPI

Kani Michele Mullins, FNP-C

  • Nurse Practitioner
  • Gastonia, NC
National Provider Identifier
1073047379
Registry record updated Feb 16, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Nurse PractitionerTaxonomy code 363L00000X
License
5009391 Issued in NC
Practice address
4235 S New Hope Rd Ste a
Gastonia, NC 28056-8453
Phone
(704) 825-4750
Fax
(704) 825-6985
NPI assigned
Apr 13, 2017
Last updated
Feb 16, 2022By the provider in NPPES
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Feb 16, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Nurse Practitioner 363L00000X 5009391 NC Primary

Addresses

Primary practice location

4235 S New Hope Rd Ste a
Gastonia, NC 28056-8453

Mailing address

PO Box 744786
Atlanta, GA 30374-4786
Phone (704) 834-2450

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC, SC2 enrollments
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: Yes
  • Power mobility devices: Yes
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 2

Enrollment IDStateProvider typePAC IDDetails
I20180602000031 NC Practitioner - Nurse Practitioner 7911262431 Reassigns benefits to 1 organization
I20190820003462 SC Practitioner - Nurse Practitioner 7911262431 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Nurse Practitioner
Education
Other, 2016
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Caromont Medical Group IncGroup PAC ID 3577476258, 425 clinicians

Practice addresses (Care Compare)

214 Cleveland Ave
Kings Mountain, NC 28086-3106
Phone (704) 731-1228

Hospital & facility affiliations

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
22764SCMDPsychiatry Physician
5009391NCMDNurse Practitioner

Practice roles

OrganizationSpecialtyStatusNew patients
Caromont Medical Group Inc CurrentSince May 14, 2018 Accepting new patients
Caromont Medical Group Inc CurrentSince Jun 1, 2019 Accepting new patients
Caromont Medical Group Inc CurrentSince May 14, 2018 Accepting new patients

Locations

1220 Spruce St
Belmont, NC 28012
Phone (704) 825-5333

910 E Church St
Ste A
Cherryville, NC 28021
Phone (704) 445-0422

2240 Remount Rd
Gastonia, NC 28054
Phone (704) 671-5311

2525 Court Dr
Gastonia, NC 28054
Phone (704) 834-2662

4235 S New Hope Rd
Ste A
Gastonia, NC 28056
Phone (704) 825-4750

660 Summit Crossing Pl
Ste 301
Gastonia, NC 28054
Phone (704) 854-8799

214 Cleveland Ave
Kings Mtn, NC 28086
Phone (704) 730-1228

700 N Main St
Stanley, NC 28164
Phone (704) 263-8945

1200 Village Harbor Dr
Ste D
Lake Wylie, SC 29710
Phone (704) 671-6400

Organizations & group practices 3

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

Hospital & facility affiliations 1

Hospitals and other facilities this clinician is affiliated with according to Medicare Care Compare.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1492041600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1644969600000",
    "number": "1073047379",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 744786",
            "city": "ATLANTA",
            "state": "GA",
            "postal_code": "303744786",
            "telephone_number": "704-834-2450",
            "fax_number": "704-671-5331"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4235 S NEW HOPE RD STE A",
            "city": "GASTONIA",
            "state": "NC",
            "postal_code": "280568453",
            "telephone_number": "704-825-4750",
            "fax_number": "704-825-6985"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLINS",
        "first_name": "KANI",
        "middle_name": "MICHELE",
        "credential": "FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2017-04-13",
        "last_updated": "2022-02-16",
        "certification_date": "2022-02-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NC",
            "license": "5009391",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Gastonia, NC

Sources for this page

Verify at the official NPI Registry.