Healthcare Provider Details

I. General information

NPI: 1194825729
Provider Name (Legal Business Name): KIMBERLY M MILLS M.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/24/2006
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2804 FORSYTHE AVE
MONROE LA
71201-3008
US

IV. Provider business mailing address

2804 FORSYTHE AVENUE
MONROE LA
71201
US

V. Phone/Fax

Practice location:
  • Phone: 318-388-0032
  • Fax: 318-388-0491
Mailing address:
  • Phone: 318-388-0032
  • Fax: 318-388-0491

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207NI0002X
TaxonomyClinical & Laboratory Dermatological Immunology Physician
License Number026345
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: