Provider Demographics
NPI:1790781458
Name:MCMILLAN, JULIE A (NP)
Entity Type:Individual
Prefix:
First Name:JULIE
Middle Name:A
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2001 LAUREL AVE
Mailing Address - Street 2:STE 206
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-1865
Mailing Address - Country:US
Mailing Address - Phone:865-524-3131
Mailing Address - Fax:865-212-6323
Practice Address - Street 1:2001 LAUREL AVE
Practice Address - Street 2:STE 206
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37916-1865
Practice Address - Country:US
Practice Address - Phone:865-524-3131
Practice Address - Fax:865-212-6323
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2010-07-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNRN0000079245363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN4059836OtherBCBS
TN500030629OtherRAILROAD MEDICARE
TN7269461OtherAETNA US HEALTHCARE
TN702021494OtherCARITEN HEALTHCARE
TN3909665Medicaid
TN702021494OtherCARITEN HEALTHCARE
TN3909666Medicare ID - Type Unspecified