Basic Information
| Provider Information | |||||||||
| NPI: | 1205438900 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLS | ||||||||
| FirstName: | SARAH | ||||||||
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| Mailing Information | |||||||||
| Address1: | 310 PARKVIEW CT | ||||||||
| Address2: | |||||||||
| City: | WHITEHOUSE | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757913587 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9033165879 | ||||||||
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| Practice Location | |||||||||
| Address1: | 910 E HOUSTON ST STE 600 | ||||||||
| Address2: | |||||||||
| City: | TYLER | ||||||||
| State: | TX | ||||||||
| PostalCode: | 757028304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9035262644 | ||||||||
| FaxNumber: | 9035260653 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/09/2020 | ||||||||
| LastUpdateDate: | 06/24/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 06/24/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | 1018109 | TX | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
ID Information
| ID | Type | State | Issuer | Description | 418299001 | 05 | TX | MEDICAID | P02607491 | 01 | TX | RR MCR | OTHER |