Kelly Veronica Mullen, N.P.

Primary specialty

Primary Care Nurse PractitionerTaxonomy code 363LP2300X

License

306187 Issued in NY

Practice address

121 Pulaski Rd
Kings Park, NY 11754-2539

Phone

(631) 678-8470

NPI assigned

Apr 7, 2016

Sex

Female

Sole proprietor

Yes

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

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Nurse Practitioner

State licenses

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

{
    "created_epoch": "1459987200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1734566400000",
    "number": "1487018206",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "39 SOUNDVIEW DR",
            "city": "NORTHPORT",
            "state": "NY",
            "postal_code": "117681446",
            "telephone_number": "631-678-8470"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "121 PULASKI RD",
            "city": "KINGS PARK",
            "state": "NY",
            "postal_code": "117542539",
            "telephone_number": "631-678-8470"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLEN",
        "first_name": "KELLY",
        "middle_name": "VERONICA",
        "name_prefix": "Ms.",
        "credential": "N.P.",
        "sole_proprietor": "YES",
        "sex": "F",
        "enumeration_date": "2016-04-07",
        "last_updated": "2024-12-19",
        "certification_date": "2024-12-19",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LA2200X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Adult Health",
            "state": "NY",
            "license": "F306187",
            "primary": false
        },
        {
            "code": "363LP2300X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Primary Care",
            "state": "NY",
            "license": "306187",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• Primary Care Nurse Practitioner in Kings Park, NY
• Providers in Kings Park, NY by specialty
• Primary Care Nurse Practitioner in New York

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 19, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.