Provider Demographics
NPI:1831623206
Name:MILLS, BREANNE (PA-C)
Entity type:Individual
Prefix:MS
First Name:BREANNE
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:BREANNE
Other - Middle Name:
Other - Last Name:SELVES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12200 W 106TH ST STE 320
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66215-2305
Mailing Address - Country:US
Mailing Address - Phone:816-523-7088
Mailing Address - Fax:
Practice Address - Street 1:830 SW MULVANE ST
Practice Address - Street 2:
Practice Address - City:TOPEKA
Practice Address - State:KS
Practice Address - Zip Code:66606-1654
Practice Address - Country:US
Practice Address - Phone:785-270-8625
Practice Address - Fax:785-270-8624
Is Sole Proprietor?:No
Enumeration Date:2017-04-12
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS15-01980363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant