Provider Demographics
NPI:1578267555
Name:MILLS, GRACE ELIZABETH
Entity Type:Individual
Prefix:
First Name:GRACE
Middle Name:ELIZABETH
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:GRACE
Other - Middle Name:ELIZABETH
Other - Last Name:AUSTIN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:101 COLLEGE HILL DR
Mailing Address - Street 2:
Mailing Address - City:PHILIPPI
Mailing Address - State:WV
Mailing Address - Zip Code:26416-4600
Mailing Address - Country:US
Mailing Address - Phone:800-263-1549
Mailing Address - Fax:
Practice Address - Street 1:101 COLLEGE HILL DR
Practice Address - Street 2:
Practice Address - City:PHILIPPI
Practice Address - State:WV
Practice Address - Zip Code:26416-4600
Practice Address - Country:US
Practice Address - Phone:800-263-1549
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-27
Last Update Date:2023-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant