Healthcare Provider Details

I. General information

NPI: 1073451787
Provider Name (Legal Business Name): KELSEY BARBARA MILLS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/23/2026
Last Update Date: 03/23/2026
Certification Date: 03/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 CUMMINGS CTR
BEVERLY MA
01915-6115
US

IV. Provider business mailing address

81 ORANGE ST
WALTHAM MA
02453-3921
US

V. Phone/Fax

Practice location:
  • Phone: 508-386-6704
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberRN2350113
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: