Provider Demographics
NPI:1255849964
Name:MCMILLAN, KHIRI AMIR
Entity Type:Individual
Prefix:
First Name:KHIRI
Middle Name:AMIR
Last Name:MCMILLAN
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3708 CONWAY RD
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32812-7608
Mailing Address - Country:US
Mailing Address - Phone:321-401-7026
Mailing Address - Fax:321-401-7026
Practice Address - Street 1:809 PATRICK ST
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5639
Practice Address - Country:US
Practice Address - Phone:321-401-7026
Practice Address - Fax:321-401-7026
Is Sole Proprietor?:Yes
Enumeration Date:2018-01-16
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician