Provider Demographics
NPI:1285848341
Name:MILLS, TIFFANY M (DO)
Entity Type:Individual
Prefix:
First Name:TIFFANY
Middle Name:M
Last Name:MILLS
Suffix:
Gender:F
Credentials:DO
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Mailing Address - Street 1:1709 KY ROUTE 321
Mailing Address - Street 2:SUITE 3
Mailing Address - City:PRESTONSBURG
Mailing Address - State:KY
Mailing Address - Zip Code:41653-9097
Mailing Address - Country:US
Mailing Address - Phone:606-886-8546
Mailing Address - Fax:606-886-8548
Practice Address - Street 1:1709 KY ROUTE 321
Practice Address - Street 2:SUITE 3
Practice Address - City:PRESTONSBURG
Practice Address - State:KY
Practice Address - Zip Code:41653-9097
Practice Address - Country:US
Practice Address - Phone:606-886-8546
Practice Address - Fax:606-886-8548
Is Sole Proprietor?:No
Enumeration Date:2007-05-09
Last Update Date:2015-09-30
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Provider Licenses
StateLicense IDTaxonomies
KY03128208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100057340Medicaid