Provider Demographics
NPI:1467418913
Name:MILLS, VERNON A (MD)
Entity Type:Individual
Prefix:
First Name:VERNON
Middle Name:A
Last Name:MILLS
Suffix:
Gender:M
Credentials:MD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3550 S 4TH ST
Mailing Address - Street 2:SUITE 120
Mailing Address - City:LEAVENWORTH
Mailing Address - State:KS
Mailing Address - Zip Code:66048-5061
Mailing Address - Country:US
Mailing Address - Phone:913-772-6046
Mailing Address - Fax:913-758-0500
Practice Address - Street 1:3550 S. 4TH ST.
Practice Address - Street 2:SUITE 120
Practice Address - City:LEAVENWORTH
Practice Address - State:KS
Practice Address - Zip Code:66048-5061
Practice Address - Country:US
Practice Address - Phone:913-772-6046
Practice Address - Fax:913-758-0500
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-25
Last Update Date:2012-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS04-18633208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics