Provider Demographics
NPI:1598206989
Name:MILLS, MARY KATHRYN (FNP-C)
Entity Type:Individual
Prefix:MISS
First Name:MARY
Middle Name:KATHRYN
Last Name:MILLS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5690 SHAFFER RD
Mailing Address - Street 2:
Mailing Address - City:DU BOIS
Mailing Address - State:PA
Mailing Address - Zip Code:15801-3870
Mailing Address - Country:US
Mailing Address - Phone:814-375-6817
Mailing Address - Fax:814-375-0922
Practice Address - Street 1:5690 SHAFFER RD
Practice Address - Street 2:
Practice Address - City:DU BOIS
Practice Address - State:PA
Practice Address - Zip Code:15801-3870
Practice Address - Country:US
Practice Address - Phone:814-375-6817
Practice Address - Fax:814-375-0922
Is Sole Proprietor?:No
Enumeration Date:2017-03-17
Last Update Date:2022-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024174494363LF0000X
PASP024538363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily