Provider Demographics
NPI:1437664984
Name:MILLIS, KARA (RDN, LDN)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:
Last Name:MILLIS
Suffix:
Gender:F
Credentials:RDN, LDN
Other - Prefix:
Other - First Name:KARA
Other - Middle Name:
Other - Last Name:WILCOXON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1000 HEALTH CENTER DR
Mailing Address - Street 2:
Mailing Address - City:MATTOON
Mailing Address - State:IL
Mailing Address - Zip Code:61938-4644
Mailing Address - Country:US
Mailing Address - Phone:765-505-7019
Mailing Address - Fax:
Practice Address - Street 1:1000 HEALTH CENTER DR
Practice Address - Street 2:
Practice Address - City:MATTOON
Practice Address - State:IL
Practice Address - Zip Code:61938-4644
Practice Address - Country:US
Practice Address - Phone:765-505-7019
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-12-06
Last Update Date:2022-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL164007128133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered