Provider Demographics
NPI:1093856247
Name:MCMILLAN, KELLY ALLISON (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:KELLY
Middle Name:ALLISON
Last Name:MCMILLAN
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Gender:F
Credentials:PA-C
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Mailing Address - Street 1:3682 E SUNNYDALE DR
Mailing Address - Street 2:SUITE 105
Mailing Address - City:QUEEN CREEK
Mailing Address - State:AZ
Mailing Address - Zip Code:85142-7368
Mailing Address - Country:US
Mailing Address - Phone:480-882-9993
Mailing Address - Fax:480-248-2377
Practice Address - Street 1:287 E HUNT HWY
Practice Address - Street 2:SUITE 105
Practice Address - City:QUEEN CREEK
Practice Address - State:AZ
Practice Address - Zip Code:85143-5096
Practice Address - Country:US
Practice Address - Phone:480-677-8282
Practice Address - Fax:480-677-8283
Is Sole Proprietor?:No
Enumeration Date:2007-02-09
Last Update Date:2016-10-21
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Provider Licenses
StateLicense IDTaxonomies
AZ3594363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical