Provider Demographics
NPI:1497000723
Name:MILLS, LESLIE BROOKE (DO)
Entity type:Individual
Prefix:DR
First Name:LESLIE
Middle Name:BROOKE
Last Name:MILLS
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:2200 E PARRISH AVE STE 205
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42303-1449
Mailing Address - Country:US
Mailing Address - Phone:270-663-1078
Mailing Address - Fax:270-663-1079
Practice Address - Street 1:2200 E PARRISH AVE STE 205
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42303-1449
Practice Address - Country:US
Practice Address - Phone:270-663-1078
Practice Address - Fax:573-234-1771
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2021-07-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2018030154207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty