Provider Demographics
NPI:1629109616
Name:MILLIKEN, KATHLEEN (CRNP)
Entity Type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:
Last Name:MILLIKEN
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:229 BISHOPS DR.
Mailing Address - Street 2:PO BOX 343
Mailing Address - City:CHESTER HEIGHTS
Mailing Address - State:PA
Mailing Address - Zip Code:19017-0343
Mailing Address - Country:US
Mailing Address - Phone:484-574-6567
Mailing Address - Fax:
Practice Address - Street 1:196 W SPROUL RD
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:PA
Practice Address - Zip Code:19064-2045
Practice Address - Country:US
Practice Address - Phone:610-338-2796
Practice Address - Fax:610-338-2797
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PASPOO7296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily