Provider Demographics
NPI:1659746477
Name:MCMILLEN, KASSANDRA KAY (MD,)
Entity type:Individual
Prefix:DR
First Name:KASSANDRA
Middle Name:KAY
Last Name:MCMILLEN
Suffix:
Gender:
Credentials:MD,
Other - Prefix:
Other - First Name:KASSANDRA
Other - Middle Name:
Other - Last Name:THOMAS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2350 MEADOWS BLVD
Mailing Address - Street 2:
Mailing Address - City:CASTLE ROCK
Mailing Address - State:CO
Mailing Address - Zip Code:80109-8405
Mailing Address - Country:US
Mailing Address - Phone:720-455-0350
Mailing Address - Fax:720-455-0351
Practice Address - Street 1:2350 MEADOWS BLVD
Practice Address - Street 2:
Practice Address - City:CASTLE ROCK
Practice Address - State:CO
Practice Address - Zip Code:80109-8405
Practice Address - Country:US
Practice Address - Phone:720-455-0350
Practice Address - Fax:720-455-0351
Is Sole Proprietor?:No
Enumeration Date:2015-12-04
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CODR0060302207V00000X
CA1207V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207V00000XAllopathic & Osteopathic PhysiciansObstetrics & Gynecology
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO029358OtherKAISER COMMERCIAL NUMBER
CO9000167241Medicaid