Provider Demographics
NPI:1811040884
Name:MILLS, ALICE (FNP)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1410 DOCTORS DR
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-4754
Mailing Address - Country:US
Mailing Address - Phone:417-256-2225
Mailing Address - Fax:417-256-2373
Practice Address - Street 1:1410 DOCTORS DR
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-4754
Practice Address - Country:US
Practice Address - Phone:417-256-2225
Practice Address - Fax:417-256-2373
Is Sole Proprietor?:No
Enumeration Date:2007-01-20
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO103151363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
186757OtherBCBS
MO426025201Medicaid
810574637OtherTRICARE
MO426025201Medicaid
MO000014510Medicare PIN