MEDICARE: CALLIE JAN PRUITT MILLS PA-C

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363A00000X	Physician Assistant	PA202631	OR

General Provider Information

NPI Number	:	1871159954
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CALLIE JAN PRUITT MILLS PA-C

Provider Business Mailing Address
First Line	:	2821 DAGGETT AVE STE 100
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1130
Country	:	US
Telephone Number	:	541-274-6733
Fax Number	:	541-274-4225

Provider Business Practice Location Address
First Line	:	2821 DAGGETT AVE STE 100
Second Line	:
City	:	KLAMATH FALLS
State	:	OR
Zip	:	97601-1130
Country	:	US
Telephone Number	:	541-274-6733
Fax Number	:	541-274-4225

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/14/2019
Last Update Date	:	01/13/2026

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