Provider Demographics
NPI:1033360102
Name:MILLARD, KATHRYN (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:
Last Name:MILLARD
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1791 HUBBARD RD
Mailing Address - Street 2:
Mailing Address - City:EAST AURORA
Mailing Address - State:NY
Mailing Address - Zip Code:14052-3031
Mailing Address - Country:US
Mailing Address - Phone:716-512-9520
Mailing Address - Fax:716-822-8165
Practice Address - Street 1:2101 SPRUCE ST
Practice Address - Street 2:
Practice Address - City:NORTH COLLINS
Practice Address - State:NY
Practice Address - Zip Code:14111-9701
Practice Address - Country:US
Practice Address - Phone:716-337-3706
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-10-07
Last Update Date:2023-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401136363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health