Provider Demographics
NPI:1245698711
Name:MCMILLEN, DAVID MICHAEL (NP-C)
Entity type:Individual
Prefix:
First Name:DAVID
Middle Name:MICHAEL
Last Name:MCMILLEN
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5482 HIGHWAY 15 N
Mailing Address - Street 2:
Mailing Address - City:ECRU
Mailing Address - State:MS
Mailing Address - Zip Code:38841-8471
Mailing Address - Country:US
Mailing Address - Phone:662-488-8799
Mailing Address - Fax:662-488-8729
Practice Address - Street 1:5482 HIGHWAY 15 N
Practice Address - Street 2:
Practice Address - City:ECRU
Practice Address - State:MS
Practice Address - Zip Code:38841-8471
Practice Address - Country:US
Practice Address - Phone:662-488-8799
Practice Address - Fax:662-488-8729
Is Sole Proprietor?:No
Enumeration Date:2016-01-29
Last Update Date:2020-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR858462163W00000X, 363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS01187262Medicaid