Provider Demographics
NPI:1366580003
Name:MILLS, KATHY (LPN)
Entity type:Individual
Prefix:
First Name:KATHY
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3882 PETERSBURG RD
Mailing Address - Street 2:
Mailing Address - City:BURLINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:41005-8778
Mailing Address - Country:US
Mailing Address - Phone:859-586-9949
Mailing Address - Fax:859-586-2359
Practice Address - Street 1:3882 PETERSBURG RD
Practice Address - Street 2:
Practice Address - City:BURLINGTON
Practice Address - State:KY
Practice Address - Zip Code:41005-8778
Practice Address - Country:US
Practice Address - Phone:859-586-9949
Practice Address - Fax:859-586-2359
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-02
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHPN 074751164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2523344Medicare ID - Type UnspecifiedOH DEPT JOBS AND FAMILY S