Kristina Dawn Mullins, PA C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

00830 Issued in WV

Practice address

14827 Soaring Eagle CT
Fort Myers, FL 33912-1827

Phone

(304) 881-6417

NPI assigned

Jan 9, 2006

Sex

Female

Sole proprietor

No

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

Specialties & licenses 3

Addresses

Other identifiers 4

Other names 1

• Ms. Kristina Dawn Chafin Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Enrolled

Credentials

Physician Assistant

State licenses

Practice roles

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.

• Dwic of Tampa Bay, Inc

  dba MedExpress Urgent Care - Hudson, State Road 52

  • Urgent Care Clinic/Center
  • Hudson, FL
  • NPI 1598132490
  NPD (past)

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

{
    "created_epoch": "1136764800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1491868800000",
    "number": "1598743593",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "14827 SOARING EAGLE CT",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339121827",
            "telephone_number": "304-881-6417"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14827 SOARING EAGLE CT",
            "city": "FORT MYERS",
            "state": "FL",
            "postal_code": "339121827",
            "telephone_number": "304-881-6417"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLINS",
        "first_name": "KRISTINA",
        "middle_name": "DAWN",
        "name_prefix": "Mrs.",
        "credential": "PA C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2006-01-09",
        "last_updated": "2017-04-11",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "WV",
            "license": "00830",
            "primary": true
        },
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "OH",
            "license": "50-002366",
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NC",
            "license": "0010-00891",
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "0127974000",
            "state": "WV"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0127483000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "0126752000",
            "state": "WV"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "MEDICAID",
            "identifier": "0126874000",
            "state": "WV"
        }
    ],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "KRISTINA",
            "last_name": "CHAFIN",
            "middle_name": "DAWN",
            "prefix": "MS.",
            "credential": "PA C",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

• Elenita Masamong Mulles, PT
• Gerard Mulles, MD
• Mayflor Q Mulles, P.T.
• Suzanne Louise Mullin, PT
• Keelan Mullins-Zugelder
• Multi-Care Medical of SW Florida, PLLC
• Multi-Care Orthopedics and Spinal Rehabilitation, PLLC
• Nathneal G Mulugeta, PHARMD
• Christopher Hugh Mulvey, DPT
• Johanna Mulvihill, B.S.

• Physician Assistant in Fort Myers, FL
• Providers in Fort Myers, FL by specialty
• Physician Assistant in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Apr 11, 2017; 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.