Edna Rothman Mullally, DNP, FNP-C

Primary specialty

Family Nurse PractitionerTaxonomy code 363LF0000X

License

5017152 Issued in NC

Practice address

5200 N Croatan Hwy
Kitty Hawk, NC 27949-3990

Phone

(252) 261-4187

Fax

(833) 989-2346

NPI assigned

Jul 27, 2020

Sex

Female

Sole proprietor

No

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

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in NC

Eligible to order & refer

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

Green means eligible to order or refer.

Enrollment records 1

Medicare enrollment (NPD)

Enrolled

Practice roles

Locations

Interoperability endpoints

• FHIR API: https://api.platform.athenahealth.com/24390/brand/1/csg/1/fhir/r4
• Direct secure messaging: edna.mullally.1@24390.direct.athenahealth.com

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.

• Beach Medical PLLC

  • Multi-Specialty Clinic/Center
  • Kitty Hawk, NC
  • NPI 1659941078
  NPD

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

{
    "created_epoch": "1595808000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1711065600000",
    "number": "1629687553",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 2287",
            "city": "KITTY HAWK",
            "state": "NC",
            "postal_code": "279492287",
            "telephone_number": "252-261-4187",
            "fax_number": "833-989-2346"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5200 N CROATAN HWY",
            "city": "KITTY HAWK",
            "state": "NC",
            "postal_code": "279493990",
            "telephone_number": "252-261-4187",
            "fax_number": "833-989-2346"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLALLY",
        "first_name": "EDNA",
        "middle_name": "ROTHMAN",
        "credential": "DNP, FNP-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2020-07-27",
        "last_updated": "2024-03-22",
        "certification_date": "2024-03-22",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363LF0000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner, Family",
            "state": "NC",
            "license": "5017152",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Tarra O Midgette, FNP
• Adam Miller
• Cheryl Ann Miller
• Michael B. Morgan, D.D.S.
• Jaclyn Grace Mounie, PT
• Obx Optix Optometric, PLLC
• Obxmd, P.C.
• Tammy Sue Odell, MA CCC/SLP
• Outer Banks Physical Therapy, LLC
• Outer Banks Speech and Language PLLC

• Family Nurse Practitioner in Kitty Hawk, NC
• Providers in Kitty Hawk, NC by specialty
• Family Nurse Practitioner in North Carolina

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 22, 2024; 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.