Provider Demographics
NPI:1740687466
Name:MILANEY, KIMBERLY (APRN)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MILANEY
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:44 OUTLOOK AVE
Mailing Address - Street 2:
Mailing Address - City:WEST HARTFORD
Mailing Address - State:CT
Mailing Address - Zip Code:06119-1431
Mailing Address - Country:US
Mailing Address - Phone:860-840-3878
Mailing Address - Fax:860-840-3878
Practice Address - Street 1:44 OUTLOOK AVE
Practice Address - Street 2:
Practice Address - City:WEST HARTFORD
Practice Address - State:CT
Practice Address - Zip Code:06119-1431
Practice Address - Country:US
Practice Address - Phone:860-840-3878
Practice Address - Fax:860-840-3878
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-24
Last Update Date:2024-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CT5999363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CT13579906OtherCAQH
CTD400236916Medicare PIN