Provider Demographics
NPI:1346726429
Name:MILLS, KATHY LYNN
Entity Type:Individual
Prefix:
First Name:KATHY
Middle Name:LYNN
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KATHY
Other - Middle Name:LYNN
Other - Last Name:MILBERGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:73 CHEYENNE TRL
Mailing Address - Street 2:
Mailing Address - City:BELTON
Mailing Address - State:TX
Mailing Address - Zip Code:76513-6427
Mailing Address - Country:US
Mailing Address - Phone:254-727-8512
Mailing Address - Fax:
Practice Address - Street 1:73 CHEYENNE TRL
Practice Address - Street 2:
Practice Address - City:BELTON
Practice Address - State:TX
Practice Address - Zip Code:76513-6427
Practice Address - Country:US
Practice Address - Phone:254-727-8512
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-07-12
Last Update Date:2018-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX945251163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX945251OtherTX RN LICENSE