Provider Demographics
NPI:1740611920
Name:MILLS, STACEY N (C-FNP)
Entity Type:Individual
Prefix:
First Name:STACEY
Middle Name:N
Last Name:MILLS
Suffix:
Gender:F
Credentials:C-FNP
Other - Prefix:
Other - First Name:STACEY
Other - Middle Name:N
Other - Last Name:VALENTINE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 609
Mailing Address - Street 2:
Mailing Address - City:ELIZABETH
Mailing Address - State:WV
Mailing Address - Zip Code:26143-0609
Mailing Address - Country:US
Mailing Address - Phone:304-275-3301
Mailing Address - Fax:304-275-4798
Practice Address - Street 1:483 COURT STREET
Practice Address - Street 2:
Practice Address - City:ELIZABETH
Practice Address - State:WV
Practice Address - Zip Code:26143-0609
Practice Address - Country:US
Practice Address - Phone:304-275-3301
Practice Address - Fax:304-275-4798
Is Sole Proprietor?:No
Enumeration Date:2013-12-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV78599363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV78599OtherLICENSE
WV78599OtherLICENSE