Provider Demographics
NPI:1619962453
Name:MILLIGAN, DONNA KATHLEEN (PA)
Entity Type:Individual
Prefix:
First Name:DONNA
Middle Name:KATHLEEN
Last Name:MILLIGAN
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:DONNA
Other - Middle Name:KATHLEEN
Other - Last Name:GELLENTHIN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:PA
Mailing Address - Street 1:3100 INDEPENDENCE SQ
Mailing Address - Street 2:
Mailing Address - City:WEST PLAINS
Mailing Address - State:MO
Mailing Address - Zip Code:65775-4235
Mailing Address - Country:US
Mailing Address - Phone:417-255-1373
Mailing Address - Fax:417-256-5040
Practice Address - Street 1:3100 INDEPENDENCE SQ
Practice Address - Street 2:
Practice Address - City:WEST PLAINS
Practice Address - State:MO
Practice Address - Zip Code:65775-4235
Practice Address - Country:US
Practice Address - Phone:417-255-1373
Practice Address - Fax:417-256-5040
Is Sole Proprietor?:No
Enumeration Date:2005-09-19
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2002013040363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO205810708Medicaid
MO000085327Medicare ID - Type Unspecified
MO205810708Medicaid