Provider Demographics
NPI:1841215464
Name:MILLS, KIMBERLY S
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:S
Last Name:MILLS
Suffix:
Gender:
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:48 MEDICAL PARK DR E STE 458
Mailing Address - Street 2:
Mailing Address - City:BIRMINGHAM
Mailing Address - State:AL
Mailing Address - Zip Code:35235-3473
Mailing Address - Country:US
Mailing Address - Phone:205-900-2000
Mailing Address - Fax:205-838-4525
Practice Address - Street 1:48 MEDICAL PARK DR E STE 458
Practice Address - Street 2:
Practice Address - City:BIRMINGHAM
Practice Address - State:AL
Practice Address - Zip Code:35235-3473
Practice Address - Country:US
Practice Address - Phone:205-900-2000
Practice Address - Fax:205-838-4525
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-13
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY008887363A00000X
TN4580363A00000X
ALPA.1374363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant