Provider Demographics
NPI:1184604852
Name:MCMILLAN, ROBIN S (FNP)
Entity type:Individual
Prefix:MRS
First Name:ROBIN
Middle Name:S
Last Name:MCMILLAN
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 W. RAVINE ST.
Mailing Address - Street 2:SUITE 9-I
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37660-3837
Mailing Address - Country:US
Mailing Address - Phone:423-224-5699
Mailing Address - Fax:
Practice Address - Street 1:146 WEST PARK DRIVE, SUITE 9-I
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37660-3835
Practice Address - Country:US
Practice Address - Phone:423-224-5699
Practice Address - Fax:423-224-4974
Is Sole Proprietor?:No
Enumeration Date:2006-01-19
Last Update Date:2012-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNAPN0000012180363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN103I502836Medicare PIN
DEQ45176Medicare UPIN
TN3341062Medicare PIN