Provider Demographics
NPI:1750669537
Name:MILL, BETTY TEMPLES (NURSE PRACTITIONER)
Entity type:Individual
Prefix:
First Name:BETTY
Middle Name:TEMPLES
Last Name:MILL
Suffix:
Gender:F
Credentials:NURSE PRACTITIONER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1694
Mailing Address - Street 2:
Mailing Address - City:KILMARNOCK
Mailing Address - State:VA
Mailing Address - Zip Code:22482-1694
Mailing Address - Country:US
Mailing Address - Phone:804-435-0575
Mailing Address - Fax:804-435-9017
Practice Address - Street 1:51 WILLIAM B GRAHAM CT
Practice Address - Street 2:
Practice Address - City:KILMARNOCK
Practice Address - State:VA
Practice Address - Zip Code:22482-3852
Practice Address - Country:US
Practice Address - Phone:804-435-0575
Practice Address - Fax:804-435-9017
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-28
Last Update Date:2011-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024110321363LA2200X, 363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care