Provider Demographics
NPI:1477847515
Name:MILLIGAN, KIMBERLY LARNELL
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LARNELL
Last Name:MILLIGAN
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 1:2043 HALSEY DR
Mailing Address - Street 2:
Mailing Address - City:KEY WEST
Mailing Address - State:FL
Mailing Address - Zip Code:33040-7077
Mailing Address - Country:US
Mailing Address - Phone:757-289-8997
Mailing Address - Fax:
Practice Address - Street 1:1205 4TH ST
Practice Address - Street 2:
Practice Address - City:KEY WEST
Practice Address - State:FL
Practice Address - Zip Code:33040-3707
Practice Address - Country:US
Practice Address - Phone:305-434-7660
Practice Address - Fax:305-292-6723
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-07
Last Update Date:2014-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator