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:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1818 WALLACE CT STE 301
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-2462
Mailing Address - Country:US
Mailing Address - Phone:270-842-1999
Mailing Address - Fax:270-904-4113
Practice Address - Street 1:1818 WALLACE CT STE 301
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42103-2462
Practice Address - Country:US
Practice Address - Phone:270-842-1999
Practice Address - Fax:270-904-4113
Is Sole Proprietor?:No
Enumeration Date:2012-07-24
Last Update Date:2025-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY05076207N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes207N00000XAllopathic & Osteopathic PhysiciansDermatologyGroup - Single Specialty