Individual provider Active NPI

Kristina Mullen, PA-C

  • Physician Assistant
  • Concord, NC
National Provider Identifier
1124505706
Registry record updated Jul 25, 2018
On this page

Key facts

NPPES NPI Registry
Primary specialty
Physician AssistantTaxonomy code 363A00000X
License
0010-08198 Issued in NC
Practice address
280 Executive Park Dr Ste 100
Concord, NC 28025-1838
Phone
(704) 948-8699
NPI assigned
Jul 25, 2018
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 25, 2018

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Physician Assistant 363A00000X 0010-08198 NC Primary

Addresses

Primary practice location

280 Executive Park Dr Ste 100
Concord, NC 28025-1838

Mailing address

426 Counselors Way Apt 307
Fort Mill, SC 29708-8635
Phone (803) 371-7217

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in NC
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 1

Enrollment IDStateProvider typePAC IDDetails
I20191120000861 NC Practitioner - Physician Assistant 5991137564 Reassigns benefits to 1 organization

Care Compare profile

Medicare Care Compare
Specialty
Physician Assistant
Education
Other, 2018
Medicare assignment
Accepts the Medicare-approved amount as payment in full
Telehealth
Offers telehealth services
Group practices
Mindpath Care Centers North Carolina PLLCGroup PAC ID 4688655517, 115 clinicians

Practice addresses (Care Compare)

4 Doctors Park
Suite H
Asheville, NC 28801-4523
Phone (828) 633-6070

6060 Piedmont Row Dr S
Suite 500
Charlotte, NC 28287-3803
Phone (980) 326-3277

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Physician Assistant

State licenses

LicenseStateTypeSpecialty
0010-08198NCMDPhysician Assistant

Interoperability endpoints

  • Direct secure messaging: mpsc.kristinamullen@114018.advancedmd-direct.com

Organizations & group practices 1

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

NPI Registry JSON

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

{
    "created_epoch": "1532476800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1532476800000",
    "number": "1124505706",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "426 COUNSELORS WAY APT 307",
            "city": "FORT MILL",
            "state": "SC",
            "postal_code": "297088635",
            "telephone_number": "803-371-7217"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "280 EXECUTIVE PARK DR STE 100",
            "city": "CONCORD",
            "state": "NC",
            "postal_code": "280251838",
            "telephone_number": "704-948-8699"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLEN",
        "first_name": "KRISTINA",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2018-07-25",
        "last_updated": "2018-07-25",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "NC",
            "license": "0010-08198",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Concord, NC

Sources for this page

Verify at the official NPI Registry.