Individual provider Active NPI

Michael Whigger Mullins, R.N.

  • Clinical Social Worker
  • Creve Coeur, MO
National Provider Identifier
1972841633
Registry record updated Dec 17, 2019
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
2015043581 Issued in MO
Practice address
11709 Old Ballas Rd Ste 205
Creve Coeur, MO 63141-7029
Phone
(314) 422-5114
NPI assigned
Jan 30, 2013
Sex
Male
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Dec 17, 2019

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

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 2015043581 MO Primary

Addresses

Primary practice location

11709 Old Ballas Rd Ste 205
Creve Coeur, MO 63141-7029

Mailing address

11709 Old Ballas Rd Ste 205
Creve Coeur, MO 63141-7029
Phone (314) 422-5114

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Not enrolled
Credentials
Registered Nurse

State licenses

LicenseStateTypeSpecialty
2015043581MOMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Core Counseling and Consulting Clinical Current Accepting new patients

Locations

11709 Old Ballas Rd
Ste 205
Saint Louis, MO 63141
Phone (314) 422-5114

Organizations & group practices 1

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.

NPI Registry JSON

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

{
    "created_epoch": "1359504000000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1576540800000",
    "number": "1972841633",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "11709 OLD BALLAS RD STE 205",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631417029",
            "telephone_number": "314-422-5114"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "11709 OLD BALLAS RD STE 205",
            "city": "CREVE COEUR",
            "state": "MO",
            "postal_code": "631417029",
            "telephone_number": "314-422-5114"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLINS",
        "first_name": "MICHAEL",
        "middle_name": "WHIGGER",
        "name_prefix": "Mr.",
        "credential": "R.N.",
        "sole_proprietor": "NO",
        "sex": "M",
        "enumeration_date": "2013-01-30",
        "last_updated": "2019-12-17",
        "certification_date": "2019-12-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "MO",
            "license": "2015043581",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Creve Coeur, MO

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 17, 2019; 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.