Healthcare Provider Details

I. General information

NPI: 1669725024
Provider Name (Legal Business Name): KIM A MILLS ANP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/23/2012
Last Update Date: 10/23/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1321 UNITY PL SUITE A
LAFAYETTE IN
47905-5793
US

IV. Provider business mailing address

PO BOX 4699
LAFAYETTE IN
47903-4699
US

V. Phone/Fax

Practice location:
  • Phone: 765-446-2450
  • Fax: 765-446-1083
Mailing address:
  • Phone: 765-449-2732
  • Fax: 765-449-1196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0106X
TaxonomyOccupational Health Nurse Practitioner
License Number71004193A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: