Provider Demographics
NPI:1841215464
Name:MILLS, KIMBERLY S (RPA-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:MILLS
Suffix:
Gender:F
Credentials:RPA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:129 N LOCUST AVE
Mailing Address - Street 2:
Mailing Address - City:LAWRENCEBURG
Mailing Address - State:TN
Mailing Address - Zip Code:38464-3757
Mailing Address - Country:US
Mailing Address - Phone:931-762-7232
Mailing Address - Fax:931-762-7234
Practice Address - Street 1:FAST PACE MEDICAL CLINIC
Practice Address - Street 2:129 N LOCUST AVENUE
Practice Address - City:LAWRENCEBURG
Practice Address - State:TN
Practice Address - Zip Code:38464
Practice Address - Country:US
Practice Address - Phone:931-762-7232
Practice Address - Fax:931-762-7234
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2022-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008887363A00000X
TN4580363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant