Provider Demographics
NPI:1578511168
Name:MACMILLAN, KAYA MALENE (DHSC, MPAS, PA-C)
Entity Type:Individual
Prefix:MS
First Name:KAYA
Middle Name:MALENE
Last Name:MACMILLAN
Suffix:
Gender:F
Credentials:DHSC, MPAS, PA-C
Other - Prefix:
Other - First Name:KAYA
Other - Middle Name:MALENE MACMILLAN
Other - Last Name:FOX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:DHSC
Mailing Address - Street 1:1441 N 12TH ST
Mailing Address - Street 2:TRANSPLANT INSTITUTE 2ND FLOOR
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85006-2837
Mailing Address - Country:US
Mailing Address - Phone:602-521-5800
Mailing Address - Fax:602-521-5332
Practice Address - Street 1:1441 N 12TH ST
Practice Address - Street 2:TRANSPLANT INSTITUTE 2ND FLOOR
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85006-2837
Practice Address - Country:US
Practice Address - Phone:602-521-5800
Practice Address - Fax:602-521-5332
Is Sole Proprietor?:No
Enumeration Date:2006-05-05
Last Update Date:2016-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ3572363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ142336OtherARIZONA MEDICARE PART B
P49630Medicare UPIN
P49630Medicare UPIN