Provider Demographics
NPI:1295089845
Name:MILLS, DAVID L (HIS)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:L
Last Name:MILLS
Suffix:
Gender:M
Credentials:HIS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:375 THOMAS MORE PKWY
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW HILLS
Mailing Address - State:KY
Mailing Address - Zip Code:41017-2176
Mailing Address - Country:US
Mailing Address - Phone:859-341-4525
Mailing Address - Fax:859-341-4993
Practice Address - Street 1:375 THOMAS MORE PKWY
Practice Address - Street 2:
Practice Address - City:CRESTVIEW HILLS
Practice Address - State:KY
Practice Address - Zip Code:41017-2176
Practice Address - Country:US
Practice Address - Phone:859-341-4525
Practice Address - Fax:859-341-4993
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-05
Last Update Date:2012-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY912237700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes237700000XSpeech, Language and Hearing Service ProvidersHearing Instrument Specialist