Provider Demographics
NPI:1548060460
Name:MILLS, KATHRYN ELISE (APRN)
Entity type:Individual
Prefix:MRS
First Name:KATHRYN
Middle Name:ELISE
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 1:6014 STONECHASE BLVD
Mailing Address - Street 2:
Mailing Address - City:PACE
Mailing Address - State:FL
Mailing Address - Zip Code:32571-7621
Mailing Address - Country:US
Mailing Address - Phone:850-512-9077
Mailing Address - Fax:
Practice Address - Street 1:5855 CREEK STATION DR
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32504-8626
Practice Address - Country:US
Practice Address - Phone:850-480-3075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-03-18
Last Update Date:2025-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL11037783207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine