Healthcare Provider Details

I. General information

NPI: 1194314963
Provider Name (Legal Business Name): CHASITY JANAE MILLS APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2021
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

85 HIGHWAY 80
MANCHESTER KY
40962-8801
US

IV. Provider business mailing address

85 HIGHWAY 80
MANCHESTER KY
40962-8801
US

V. Phone/Fax

Practice location:
  • Phone: 606-596-0410
  • Fax:
Mailing address:
  • Phone: 606-596-0410
  • Fax: 606-598-1117

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number3015662
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: