Look up the most recent NPI and PECOS records

Kathleen Ellen Mullen

Nurse Practitioner

Physician Assistants & Advanced Practice Nursing Providers

4500 San Pablo Rd S, Jacksonville, FL 32224-1865

(904) 953-2000 (904) 345-7776

PECOS Enrollment

This provider is enrolled in PECOS as KATHLEEN MULLEN.

Based on the most recent information from CMS, provider Kathleen Ellen Mullen is legally eligible to order and refer claims for DME and PMD services only.

Part B
Medicare Part B
Not Enrolled
HHA
Home Health Agency
Not Enrolled
DME
Durable Medical Equipment
Enrolled
PMD
Power Mobility Device
Enrolled

CMS last updated its PECOS records 8 days ago.

Profile Details

Provider ID
1205827391
Provider Type
Individual
Full Name
Mullen, Kathleen Ellen
Title
Ms.

Credential
ARNP
Gender
Female
Enumeration Date
10/29/2005
Last Updated
11/29/2016

Contact Information

Practice Location

4500 San Pablo Rd S, Jacksonville, FL 32224-1865

(904) 953-2000

Unlisted Fax

Mailing Location

3599 University Blvd S, Jacksonville, FL 32216-4252

(904) 345-7776

(904) 345-7772

Provider Taxonomies

Code	Description	License
Code 363L00000X Primary	Description Nurse Practitioner Physician Assistants & Advanced Practice Nursing Providers	License ARNP1985832 Florida

Provider Identifiers

ID	Description	Issuer
ID 306261900	Description Medicaid	Issuer Unlisted Florida
ID Y050T	Description Other	Issuer BLUECROSS/BLUESHIELD Florida
ID P00153960	Description Other	Issuer RAILROAD MEDICARE Florida

Kathleen Ellen Mullen

PECOS Enrollment

Profile Details

Contact Information

Practice Location

Mailing Location

Provider Taxonomies

Code

Description

License

Code

Description

License

Provider Identifiers

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

ID

Description

Issuer

Romecki, Bree Z Brasch

Hartley, Michel

Segars, Kelly White

Ahn, Ana Gabriela

Kapp, Melissa Diane

Mazer, Laura S

Thornton, Lucy Holly

Martin, Angela

Rogers, Emily Rose

King, Courtney Renee