Healthcare Provider Details

I. General information

NPI: 1316656457
Provider Name (Legal Business Name): HEATHER MARIE MILLS APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MRS. HEATHER MARIE WHITE

II. Dates (important events)

Enumeration Date: 11/17/2022
Last Update Date: 11/30/2022
Certification Date: 11/30/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 BOB O LINK DR STE 100
LEXINGTON KY
40504-3760
US

IV. Provider business mailing address

PO BOX 936
LONDON KY
40743-0936
US

V. Phone/Fax

Practice location:
  • Phone: 859-277-3737
  • Fax: 859-685-0161
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number2048527
License Number StateKY
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3017928
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: