Provider Demographics
NPI:1023350048
Name:MILLS, SHARA E (APRN)
Entity type:Individual
Prefix:MRS
First Name:SHARA
Middle Name:E
Last Name:MILLS
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1305 N ELM ST
Mailing Address - Street 2:
Mailing Address - City:HENDERSON
Mailing Address - State:KY
Mailing Address - Zip Code:42420-2783
Mailing Address - Country:US
Mailing Address - Phone:270-631-2412
Mailing Address - Fax:270-827-7475
Practice Address - Street 1:1284 US HIGHWAY 60 W
Practice Address - Street 2:
Practice Address - City:MORGANFIELD
Practice Address - State:KY
Practice Address - Zip Code:42437-6236
Practice Address - Country:US
Practice Address - Phone:270-389-2323
Practice Address - Fax:270-389-0526
Is Sole Proprietor?:No
Enumeration Date:2013-03-18
Last Update Date:2021-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1079483163W00000X
KY3008154364SA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100254150Medicaid
KY000000844683OtherANTHEM ID
KY000000844683OtherANTHEM ID