Provider Demographics
NPI:1184763963
Name:MILLS, JESSICA L (APRN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:L
Last Name:MILLS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:850 RIVERVIEW AVE
Mailing Address - Street 2:
Mailing Address - City:PINEVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40977
Mailing Address - Country:US
Mailing Address - Phone:606-337-7779
Mailing Address - Fax:606-337-5437
Practice Address - Street 1:850 RIVERVIEW AVE
Practice Address - Street 2:
Practice Address - City:PINEVILLE
Practice Address - State:KY
Practice Address - Zip Code:40977
Practice Address - Country:US
Practice Address - Phone:606-337-7779
Practice Address - Fax:606-337-5437
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2015-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3003460363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100130530Medicaid