Provider Demographics
NPI:1992526404
Name:MILLS-SHARP, AMY RACHELLE (PRSS)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:RACHELLE
Last Name:MILLS-SHARP
Suffix:
Gender:F
Credentials:PRSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2508 N NOTTINGHAM WAY APT 19
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-1240
Mailing Address - Country:US
Mailing Address - Phone:405-435-1349
Mailing Address - Fax:
Practice Address - Street 1:2508 N NOTTINGHAM WAY APT 19
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-1240
Practice Address - Country:US
Practice Address - Phone:405-435-1349
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-18
Last Update Date:2024-10-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist