Provider Demographics
NPI:1558872663
Name:MCMILLIN, SHARON
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:MCMILLIN
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 1:936 COAL BLUFF RD
Mailing Address - Street 2:
Mailing Address - City:LENA
Mailing Address - State:MS
Mailing Address - Zip Code:39094-9027
Mailing Address - Country:US
Mailing Address - Phone:601-504-5636
Mailing Address - Fax:
Practice Address - Street 1:17280 HIGHWAY 17
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:MS
Practice Address - Zip Code:39095-6614
Practice Address - Country:US
Practice Address - Phone:662-834-2566
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-16
Last Update Date:2024-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS902206363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily