Stevie-Marie Ann Mullins, PA-C

Primary specialty

Physician AssistantTaxonomy code 363A00000X

License

13155157-1206 Issued in UT

Practice address

1222 W Legacy Crossing Blvd Ste 200
Centerville, UT 84014-5560

Phone

(801) 298-3802

NPI assigned

Nov 29, 2022

Last updated

Mar 23, 2026By 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 3

Addresses

Medicare fee-for-service enrollment

Enrolled in UT

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

Specialty

Physician Assistant

Education

Other, 2022

Medicare assignment

Accepts the Medicare-approved amount as payment in full

Group practices

Integrated Dermatology of Bountiful LLCGroup PAC ID 6507990793, 4 clinicians

Practice addresses (Care Compare)

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, National Provider Directory roles and organizations whose NPPES authorized official is this provider.

• Integrated Dermatology of Bountiful LLC

  • Dermatology Physician
  • Centerville, UT
  • NPI 1629396841
  Medicare reassignment Care Compare group
• Real You Plastic Surgery and Wellness, LLC

  • Plastic and Reconstructive Surgery Physician
  • American Fork, UT
  • NPI 1710606975
  Medicare reassignment
• Utah Weight Loss, LLC

  • Dietary Manager
  • Provo, UT
  • NPI 1720447766
  NPD (past)

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

{
    "created_epoch": "1669680000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1774224000000",
    "number": "1760192868",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1222 W LEGACY CROSSING BLVD STE 200",
            "city": "CENTERVILLE",
            "state": "UT",
            "postal_code": "840145560",
            "telephone_number": "801-298-3802"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1222 W LEGACY CROSSING BLVD STE 200",
            "city": "CENTERVILLE",
            "state": "UT",
            "postal_code": "840145560",
            "telephone_number": "801-298-3802"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3592 W 9000 S Ste 210",
            "address_purpose": "LOCATION",
            "city": "West Jordan",
            "state": "UT",
            "postal_code": "840888819",
            "country_code": "US",
            "telephone_number": "801-298-3802",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "MULLINS",
        "first_name": "STEVIE-MARIE",
        "middle_name": "ANN",
        "credential": "PA-C",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2022-11-29",
        "last_updated": "2026-03-23",
        "certification_date": "2026-03-23",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "363A00000X",
            "taxonomy_group": "",
            "desc": "Physician Assistant",
            "state": "UT",
            "license": "13155157-1206",
            "primary": true
        },
        {
            "code": "363AM0700X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Medical",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "363AS0400X",
            "taxonomy_group": "",
            "desc": "Physician Assistant, Surgical",
            "state": "NU",
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Deanna Rae Moultrie, PHARMD
• Mountain West Podiatry LLC
• Mountain West Wound Care Inc
• Ms. Febee's Speech Center, LLC
• MTC Medical, LLC
• John Clark Nelson, MD
• Neurorev PLLC
• Seiaeo Nusi
• Willard Daniel O'Berry III, M.S.P.T.
• Oak Ridge Assisted Living

• Physician Assistant in Centerville, UT
• Providers in Centerville, UT by specialty
• Physician Assistant in Utah

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 23, 2026; 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.
• Medicare Care Compare (CMS): clinician profile, group practices, facility affiliations, MIPS scores and star ratings.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.