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General NPI Number Information
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NPI Number | 1417505413
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Entity Type | Individual
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Provider Name | ELYSE MILLS FNP-C
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Gender | Female
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Dates
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Enumeration Date | 09/03/2019
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Last Update Date | 09/25/2024
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Provider Practice Location Address
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Address Line | 411 E VAUGHN AVE STE 104
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City | RUSTON
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State | LA
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Zip | 71270-5975
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Country | US
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Telephone | 318-254-2589
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Fax | 318-255-3343
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Provider Business Mailing Address
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Address Line | 411 E VAUGHN AVE STE 104
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City | RUSTON
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State | LA
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Zip | 71270-5975
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Country | US
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Telephone | 318-254-2589
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Fax | 318-255-3343
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LF0000X
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Taxonomy Name | Family Nurse Practitioner
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License Number | 206504
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License Number State | LA
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