Provider Demographics
NPI:1134742380
Name:MILLS, KELLY ANN (LVN)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:ANN
Last Name:MILLS
Suffix:
Gender:F
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4476 ASPEN LAKE DR STE 208
Mailing Address - Street 2:
Mailing Address - City:BRUNSWICK
Mailing Address - State:OH
Mailing Address - Zip Code:44212-4539
Mailing Address - Country:US
Mailing Address - Phone:940-389-8557
Mailing Address - Fax:
Practice Address - Street 1:4476 ASPEN LAKE DR STE 208
Practice Address - Street 2:
Practice Address - City:BRUNSWICK
Practice Address - State:OH
Practice Address - Zip Code:44212-4539
Practice Address - Country:US
Practice Address - Phone:940-389-8557
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-22
Last Update Date:2020-05-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX230326164W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164W00000XNursing Service ProvidersLicensed Practical Nurse