Active NPI
Tina Marie Mullins, NP
- Nurse Practitioner
- Greenwood, IN
National Provider Identifier
1710656657
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- AG09210075
- Practice address
- 609 Thoroughbred LN
Greenwood, IN 46142-7588 - Phone
- (177) 603-3883
- NPI assigned
- Sep 13, 2021
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | AG09210075 | IN | Primary |
Addresses
Primary practice location
609 Thoroughbred LN
Greenwood, IN 46142-7588
Mailing address
609 Thoroughbred LN
Greenwood, IN 46142-7588
Phone (177) 603-3883
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Enrolled in IN
- Eligible to order & refer
- Part B services: Yes
- Medical equipment: Yes
- Home health: Yes
- Power mobility devices: Yes
- Hospice: No
Enrollment records 1
| Enrollment ID | State | Provider type | PAC ID | Details |
|---|---|---|---|---|
| I20220616001537 | IN | Order and Referring Only - Nurse Practitioner | 3971982281 |
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| AG09210075 | IN | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1631491200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1631491200000",
"number": "1710656657",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "609 THOROUGHBRED LN",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461427588",
"telephone_number": "177-603-3883"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "609 THOROUGHBRED LN",
"city": "GREENWOOD",
"state": "IN",
"postal_code": "461427588",
"telephone_number": "177-603-3883"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MULLINS",
"first_name": "TINA",
"middle_name": "MARIE",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2021-09-13",
"last_updated": "2021-09-13",
"certification_date": "2021-09-13",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "IN",
"license": "AG09210075",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Greenwood, IN
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 13, 2021; 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.