Provider Demographics
NPI:1811185044
Name:MILLS, CHRISTY DAWN (CRNA)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:DAWN
Last Name:MILLS
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:CHRISTY
Other - Middle Name:DAWN
Other - Last Name:NELSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1020 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:BEAVER DAM
Mailing Address - State:KY
Mailing Address - Zip Code:42320-1553
Mailing Address - Country:US
Mailing Address - Phone:270-274-0480
Mailing Address - Fax:270-274-0482
Practice Address - Street 1:1020 N MAIN ST
Practice Address - Street 2:
Practice Address - City:BEAVER DAM
Practice Address - State:KY
Practice Address - Zip Code:42320-1553
Practice Address - Country:US
Practice Address - Phone:270-274-0480
Practice Address - Fax:270-274-0482
Is Sole Proprietor?:No
Enumeration Date:2007-10-12
Last Update Date:2014-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3005337367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000873602OtherANTHEM PIN
KY3005337OtherLICENSE
KY7100024690Medicaid
KYK137900Medicare PIN
KY44983OtherKENTUCKY LICENSE