Provider Demographics
NPI:1205438900
Name:MILLS, SARAH
Entity type:Individual
Prefix:
First Name:SARAH
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 PARKVIEW CT
Mailing Address - Street 2:
Mailing Address - City:WHITEHOUSE
Mailing Address - State:TX
Mailing Address - Zip Code:75791-3587
Mailing Address - Country:US
Mailing Address - Phone:903-316-5879
Mailing Address - Fax:
Practice Address - Street 1:910 E HOUSTON ST STE 600
Practice Address - Street 2:
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75702-8304
Practice Address - Country:US
Practice Address - Phone:903-526-2644
Practice Address - Fax:903-526-0653
Is Sole Proprietor?:No
Enumeration Date:2020-11-09
Last Update Date:2021-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1018109363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX418299001Medicaid
TXP02607491OtherRR MCR