Provider Demographics
NPI:1417505413
Name:MILLS, ELYSE (FNP-C)
Entity type:Individual
Prefix:
First Name:ELYSE
Middle Name:
Last Name:MILLS
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 E VAUGHN AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:RUSTON
Mailing Address - State:LA
Mailing Address - Zip Code:71270-5975
Mailing Address - Country:US
Mailing Address - Phone:318-254-2589
Mailing Address - Fax:318-255-3343
Practice Address - Street 1:411 E VAUGHN AVE STE 104
Practice Address - Street 2:
Practice Address - City:RUSTON
Practice Address - State:LA
Practice Address - Zip Code:71270-5975
Practice Address - Country:US
Practice Address - Phone:318-254-2589
Practice Address - Fax:318-255-3343
Is Sole Proprietor?:No
Enumeration Date:2019-09-03
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA206504363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily