1174392914 NPI number — MRS. KAYCEE LASHAE MULLINS MSCJA

Table of content: MRS. KAYCEE LASHAE MULLINS MSCJA (NPI 1174392914)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174392914 NPI number — MRS. KAYCEE LASHAE MULLINS MSCJA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLINS
Provider First Name:
KAYCEE
Provider Middle Name:
LASHAE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
MSCJA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1174392914
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
12/21/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
355 CENTRAL AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SOUTH CHARLESTON
Provider Business Mailing Address State Name:
WV
Provider Business Mailing Address Postal Code:
25303-1709
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
304-859-0726
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2157 GREENBRIER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CHARLESTON
Provider Business Practice Location Address State Name:
WV
Provider Business Practice Location Address Postal Code:
25311-9623
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
304-344-5924
Provider Business Practice Location Address Fax Number:
304-344-3503
Provider Enumeration Date:
12/21/2023

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YA0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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