Jacob Connard Mullins, MD

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

76924 Issued in TN

Practice address

270 E Court Ave
Selmer, TN 38375-2304

Phone

(731) 645-7932

NPI assigned

Apr 5, 2023

Sex

Male

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Medicare fee-for-service enrollment

Enrolled in TN

Eligible to order & refer

• Part B services: No
• Medical equipment: Yes
• Home health: No
• Power mobility devices: Yes
• Hospice: No

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

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

{
    "created_epoch": "1680652800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1784678400000",
    "number": "1194410316",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "257 BANCORP SOUTH PKWY",
            "city": "JACKSON",
            "state": "TN",
            "postal_code": "383057582"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "270 E COURT AVE",
            "city": "SELMER",
            "state": "TN",
            "postal_code": "383752304",
            "telephone_number": "731-645-7932"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLINS",
        "first_name": "JACOB",
        "middle_name": "CONNARD",
        "credential": "MD",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2023-04-05",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TN",
            "license": "76924",
            "primary": true
        },
        {
            "code": "390200000X",
            "taxonomy_group": "",
            "desc": "Student in an Organized Health Care Education/Training Program",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Sherry M Moore, CFNP
• Carlee Elizabeth Morris
• Jennifer Bias Morris, PHARM.D.
• Charles S. Moss, R.PH.
• Mulberry Dental, PLLC
• Nicholas Matters Inc.
• Melissa B Page, MSN, FNP
• Jill Mask Parker, MACCC-SLP
• David Petty, DPH
• Tina Pezeshk

• Pediatrics Physician in Selmer, TN
• Providers in Selmer, TN by specialty
• Pediatrics Physician in Tennessee

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments; Order and Referring.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.