Jennifer Latrise Mullen, DO

Primary specialty

Pediatrics PhysicianTaxonomy code 208000000X

License

V4441 Issued in TX

Practice address

660 Beaver Creek Cir
Suite 100
Maumee, OH 43537-1745

Phone

(419) 891-6221

Fax

(419) 893-3394

NPI assigned

Jun 30, 2009

Last updated

Jan 16, 2025By the provider in NPPES

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Electronic endpoints 1

Medicare fee-for-service enrollment

Enrolled in OH, TX2 enrollments

Eligible to order & refer

• Part B services: Yes
• Medical equipment: Yes
• Home health: Yes
• Power mobility devices: Yes
• Hospice: Yes

Green means eligible to order or refer.

Enrollment records 2

Medicare enrollment (NPD)

Enrolled

Credentials

Doctor of Osteopathy

State licenses

Practice roles

Locations

Interoperability endpoints

• Direct secure messaging: jmullen28218@direct.promedica.org
• Direct secure messaging: jmullen706998@memorialhermann.direct-ci.com

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.

• Promedica Central Physicians

  • Family Medicine Physician
  • Toledo, OH
  • NPI 1043270150
  Medicare reassignment NPD
• Memorial Hermann Medical Group

  • Family Medicine Physician
  • Fulshear, TX
  • NPI 1003985102

  Pediatrics

  Medicare reassignment NPD
• Promedica Central Physicians

  dba ProMedica Physicians Durable Medical Equipment

  • Durable Medical Equipment & Medical Supplies
  • Toledo, OH
  • NPI 1669068482
  NPD
• Lima Memorial Joint Operating Company

  dba Lima Memorial Health System

  • General Acute Care Hospital
  • Lima, OH
  • NPI 1336144732
  NPD (past)

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

{
    "created_epoch": "1246320000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1736985600000",
    "number": "1588892483",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "660 BEAVER CREEK CIR",
            "address_2": "SUITE 100",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371745",
            "telephone_number": "419-891-6221",
            "fax_number": "419-893-3394"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "660 BEAVER CREEK CIR",
            "address_2": "SUITE 100",
            "city": "MAUMEE",
            "state": "OH",
            "postal_code": "435371745",
            "telephone_number": "419-891-6221",
            "fax_number": "419-893-3394"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "920 Frostwood Dr Ste 2.300",
            "address_purpose": "LOCATION",
            "city": "Houston",
            "state": "TX",
            "postal_code": "770242314",
            "country_code": "US",
            "telephone_number": "713-338-5519",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MULLEN",
        "first_name": "JENNIFER",
        "middle_name": "LATRISE",
        "credential": "DO",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2009-06-30",
        "last_updated": "2025-01-16",
        "certification_date": "2025-01-16",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "OH",
            "license": "34010645",
            "primary": false
        },
        {
            "code": "208000000X",
            "taxonomy_group": "",
            "desc": "Pediatrics",
            "state": "TX",
            "license": "V4441",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [
        {
            "endpointType": "DIRECT",
            "endpointTypeDescription": "Direct Messaging Address",
            "endpoint": "jmullen28218@epicdirect.promedica.org",
            "affiliation": "N",
            "address_1": "100 Madison Ave",
            "city": "Toledo",
            "state": "OH",
            "country_code": "US",
            "postal_code": "436041516",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "other_names": []
}

• Bobbi J Mourad, LMT
• Rachel Leigh Mowery, LICDC-CS
• Malachi Jordan Moyer, PA
• David Edwin Muck, DC
• Asish Mukherjee, M.D.
• Alexandria L Mullins, CDCA
• Savannah Mullins, RBT
• Miranda Mungarro
• Aaron Murphy, RBT
• Trenton Xavier Murry

• Pediatrics Physician in Maumee, OH
• Providers in Maumee, OH by specialty
• Pediatrics Physician in Ohio

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 16, 2025; 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.