Provider Demographics
NPI:1083969414
Name:MILLS, KIMBERLEY MICHELLE (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLEY
Middle Name:MICHELLE
Last Name:MILLS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1009 E 6TH ST
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4657
Mailing Address - Country:US
Mailing Address - Phone:361-668-8888
Mailing Address - Fax:361-664-1818
Practice Address - Street 1:1009 E 6TH ST
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4657
Practice Address - Country:US
Practice Address - Phone:361-668-8888
Practice Address - Fax:361-664-1818
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-23
Last Update Date:2012-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX596000363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily