Provider Demographics
NPI:1174859409
Name:KADNER, MILLICENT GAY (APRN)
Entity Type:Individual
Prefix:MRS
First Name:MILLICENT
Middle Name:GAY
Last Name:KADNER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
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Other - Credentials:
Mailing Address - Street 1:2200 JEFFERSON AVE
Mailing Address - Street 2:5TH FLOOR MERCY PHO/CVO
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43604-7101
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1532 LONE OAK RD STE 320
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7942
Practice Address - Country:US
Practice Address - Phone:270-415-3830
Practice Address - Fax:270-415-3831
Is Sole Proprietor?:No
Enumeration Date:2009-10-21
Last Update Date:2018-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006262363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY000000643074OtherANTHEM BC BS
KY7100098050Medicaid
KY000000643074OtherANTHEM BC BS