Provider Demographics
NPI:1871669796
Name:MULL, KEVIN RONALD (PAC)
Entity type:Individual
Prefix:
First Name:KEVIN
Middle Name:RONALD
Last Name:MULL
Suffix:
Gender:
Credentials:PAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:38229 DUPONT BLVD
Mailing Address - Street 2:
Mailing Address - City:SELBYVILLE
Mailing Address - State:DE
Mailing Address - Zip Code:19975-3045
Mailing Address - Country:US
Mailing Address - Phone:302-433-6440
Mailing Address - Fax:302-524-8282
Practice Address - Street 1:38229 DUPONT BLVD
Practice Address - Street 2:
Practice Address - City:SELBYVILLE
Practice Address - State:DE
Practice Address - Zip Code:19975-3045
Practice Address - Country:US
Practice Address - Phone:302-433-6440
Practice Address - Fax:302-524-8282
Is Sole Proprietor?:No
Enumeration Date:2006-11-24
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDC0002049363A00000X
DEC5-0011713363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant