Provider Demographics
NPI:1265878755
Name:MILLS, KIERSTEN RIANE (PA-C)
Entity type:Individual
Prefix:
First Name:KIERSTEN
Middle Name:RIANE
Last Name:MILLS
Suffix:
Gender:F
Credentials:PA-C
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Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:933 FIRST COLONIAL RD
Mailing Address - Street 2:STE 200
Mailing Address - City:VIRGINIA BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:23454-3172
Mailing Address - Country:US
Mailing Address - Phone:757-578-2260
Mailing Address - Fax:757-578-2261
Practice Address - Street 1:5226 INDIAN RIVER RD
Practice Address - Street 2:#102
Practice Address - City:VIRGINIA BEACH
Practice Address - State:VA
Practice Address - Zip Code:23464-6179
Practice Address - Country:US
Practice Address - Phone:757-216-4030
Practice Address - Fax:757-216-4029
Is Sole Proprietor?:No
Enumeration Date:2013-05-11
Last Update Date:2020-09-28
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
VA0110-004219363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical