Healthcare Provider Details

I. General information

NPI: 1740244052
Provider Name (Legal Business Name): ANN MILLS LILLY MSN
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 04/13/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 VETERANS AVE
BECKLEY WV
25801-6444
US

IV. Provider business mailing address

161 FAR COUNTRY DR
DANIELS WV
25832-9006
US

V. Phone/Fax

Practice location:
  • Phone: 304-255-2121
  • Fax: 304-255-2431
Mailing address:
  • Phone: 304-763-2378
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number27996
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: