Provider Demographics
NPI:1548979396
Name:MILLS, SHANNON ESTEL (APRN)
Entity type:Individual
Prefix:
First Name:SHANNON
Middle Name:ESTEL
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 1:315 HOSPITAL DR
Mailing Address - Street 2:
Mailing Address - City:BARBOURVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40906-7917
Mailing Address - Country:US
Mailing Address - Phone:606-277-2999
Mailing Address - Fax:606-277-0252
Practice Address - Street 1:315 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:BARBOURVILLE
Practice Address - State:KY
Practice Address - Zip Code:40906-7917
Practice Address - Country:US
Practice Address - Phone:606-546-4060
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-11-21
Last Update Date:2023-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3018679363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily