Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207QA0505X | Family Doctor - Adult Medicine | 815197 | NV |
N | 207QG0300X | Family Doctor - Geriatric Medicine | 815197 | NV |
Y | 363LF0000X | Nurse Practitioner - Family Medicine | 815197 | NV |
NPI | 1083247613 |
---|---|
Provider Name | Kayla Mcmillen |
First Address | Cerritos, CA 90703-9329 |
Second Address | Las Vegas, NV 89121-7447 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2020 |
Last Update Date | 19/03/2020 |