Provider Demographics
NPI:1619154812
Name:MILLS, CARRIE LYNN
Entity Type:Individual
Prefix:
First Name:CARRIE
Middle Name:LYNN
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 S KEENELAND DR
Mailing Address - Street 2:APT. #1
Mailing Address - City:RICHMOND
Mailing Address - State:KY
Mailing Address - Zip Code:40475-3282
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:200 S KEENELAND DR
Practice Address - Street 2:APT. #1
Practice Address - City:RICHMOND
Practice Address - State:KY
Practice Address - Zip Code:40475-3282
Practice Address - Country:US
Practice Address - Phone:859-358-6287
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-30
Last Update Date:2008-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171W00000XOther Service ProvidersContractor