Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 3011945 | KY |
NPI | 1942717152 |
---|---|
Provider Name | Vickie Ann Mills |
First Address | Gray, KY 40734-6574 |
Second Address | Gray, KY 40734-6574 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 09/01/2018 |
Last Update Date | 09/01/2018 |