Provider Demographics
NPI:1467676577
Name:MILLS, AMY HILBURN (CRNP)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:HILBURN
Last Name:MILLS
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1560 CARTER RD
Mailing Address - Street 2:
Mailing Address - City:GOSHEN
Mailing Address - State:AL
Mailing Address - Zip Code:36035-6720
Mailing Address - Country:US
Mailing Address - Phone:334-303-1407
Mailing Address - Fax:
Practice Address - Street 1:1704 S FOREST AVE
Practice Address - Street 2:
Practice Address - City:LUVERNE
Practice Address - State:AL
Practice Address - Zip Code:36049-7306
Practice Address - Country:US
Practice Address - Phone:334-335-3383
Practice Address - Fax:334-335-3078
Is Sole Proprietor?:No
Enumeration Date:2007-04-12
Last Update Date:2008-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-079830363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL51006186OtherBLUE CROSS BLUE SHIELD
AL891017415Medicaid