1235133778 NPI number — BRENDA KRIS MULLINS MD

Table of content: (NPI 1649851932)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235133778 NPI number — BRENDA KRIS MULLINS MD

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MULLINS
Provider First Name:
BRENDA
Provider Middle Name:
KRIS
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MD
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:
1235133778
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/02/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
DEPT 96-0485
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73196-0485
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-843-5855
Provider Business Mailing Address Fax Number:
405-843-5865

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1211 N SHARTEL AVE
Provider Second Line Business Practice Location Address:
SUITE 1000
Provider Business Practice Location Address City Name:
OKLAHOMA CITY
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
73103-2400
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-843-5855
Provider Business Practice Location Address Fax Number:
405-843-5865
Provider Enumeration Date:
06/13/2005

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: 207RC0000X , with the licence number:  19064 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 207RI0011X , with the licence number: 19064 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 100094930C , issued by the state of ( OK ) . This identifiers is of the category "MEDICAID".




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