Active NPI
Randy Mullinix, PA-C
- Physician Assistant
- Martinsburg, WV
National Provider Identifier
1487633038
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physician Assistant
- License
- 00201
- Practice address
- 510 Butler Ave
Mental Health Service
Martinsburg, WV 25401-9990 - Phone
- (304) 263-0811
- Fax
- (304) 264-3989
- NPI assigned
- Jan 12, 2006
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physician Assistant | 363A00000X | 00201 | WV | Primary |
Addresses
Primary practice location
510 Butler Ave
Mental Health Service
Martinsburg, WV 25401-9990
Mailing address
510 Butler Ave
Martinsburg VA Med Center/ Ward 6a
Martinsburg, WV 25405-9990
Phone (304) 263-0811
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 00201 | WV | MD | Physician Assistant |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1137024000000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1184112000000",
"number": "1487633038",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "510 BUTLER AVE",
"address_2": "MARTINSBURG VA MED CENTER/ WARD 6A",
"city": "MARTINSBURG",
"state": "WV",
"postal_code": "254059990",
"telephone_number": "304-263-0811",
"fax_number": "304-264-3989"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "510 BUTLER AVE",
"address_2": "MENTAL HEALTH SERVICE",
"city": "MARTINSBURG",
"state": "WV",
"postal_code": "254019990",
"telephone_number": "304-263-0811",
"fax_number": "304-264-3989"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLINIX",
"first_name": "RANDY",
"name_prefix": "Mr.",
"credential": "PA-C",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2006-01-12",
"last_updated": "2007-07-11",
"status": "A"
},
"taxonomies": [
{
"code": "363A00000X",
"taxonomy_group": "",
"desc": "Physician Assistant",
"state": "WV",
"license": "00201",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Martinsburg, WV
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 11, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.