Provider Demographics
NPI:1043055957
Name:MULKEY, CHARLES ALLEN-WAYNE (STUDENT)
Entity type:Individual
Prefix:
First Name:CHARLES
Middle Name:ALLEN-WAYNE
Last Name:MULKEY
Suffix:
Gender:M
Credentials:STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:302 N 3RD ST APT 513
Mailing Address - Street 2:
Mailing Address - City:SAINT JOSEPH
Mailing Address - State:MO
Mailing Address - Zip Code:64501-1856
Mailing Address - Country:US
Mailing Address - Phone:816-898-4633
Mailing Address - Fax:
Practice Address - Street 1:302 N 3RD ST APT 513
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64501-1856
Practice Address - Country:US
Practice Address - Phone:816-898-4633
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-01
Last Update Date:2024-07-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program