Provider Demographics
NPI:1093595563
Name:MILLS, CELESTE VICTORIA (RD)
Entity Type:Individual
Prefix:
First Name:CELESTE
Middle Name:VICTORIA
Last Name:MILLS
Suffix:
Gender:F
Credentials:RD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:345 BIG HILL AVE
Mailing Address - Street 2:
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-2011
Mailing Address - Country:US
Mailing Address - Phone:859-358-5440
Mailing Address - Fax:859-353-5311
Practice Address - Street 1:345 BIG HILL AVE
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-2011
Practice Address - Country:US
Practice Address - Phone:859-358-5440
Practice Address - Fax:859-353-5311
Is Sole Proprietor?:No
Enumeration Date:2023-10-03
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY265065133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered