Healthcare Provider Details

I. General information

NPI: 1851602536
Provider Name (Legal Business Name): KRISTIN T MILLS DO
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/28/2010
Last Update Date: 09/06/2022
Certification Date: 09/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

WELLSPACE HEALTH J STREET COMMUNITY HEALTH CENTER 1820 J STREET
SACRAMENTO CA
95811
US

IV. Provider business mailing address

2472 RAYWOOD VW APT 621
COLORADO SPRINGS CO
80920-7757
US

V. Phone/Fax

Practice location:
  • Phone: 916-737-5555
  • Fax:
Mailing address:
  • Phone: 240-810-2850
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207R00000X
TaxonomyInternal Medicine Physician
License NumberDR.0061815
License Number StateCO
# 2
Primary TaxonomyY
Taxonomy Code207RI0200X
TaxonomyInfectious Disease Physician
License Number20170
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: