Provider Demographics
NPI:1437629961
Name:MCMILLAN, KRISTAN KELLY
Entity Type:Individual
Prefix:
First Name:KRISTAN
Middle Name:KELLY
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19916 SE 25TH PL
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98075-9663
Mailing Address - Country:US
Mailing Address - Phone:425-606-0238
Mailing Address - Fax:
Practice Address - Street 1:4014 52ND ST NE
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98422-1980
Practice Address - Country:US
Practice Address - Phone:206-618-4673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-27
Last Update Date:2018-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician