Provider Demographics
NPI:1811745698
Name:MCMILLAN, KASEY (NP)
Entity type:Individual
Prefix:
First Name:KASEY
Middle Name:
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 1:1995 IVY MOUNTAIN RD
Mailing Address - Street 2:
Mailing Address - City:HIAWASSEE
Mailing Address - State:GA
Mailing Address - Zip Code:30546-4355
Mailing Address - Country:US
Mailing Address - Phone:706-401-2373
Mailing Address - Fax:
Practice Address - Street 1:14244 HIGHWAY 515 N UNIT 100
Practice Address - Street 2:
Practice Address - City:ELLIJAY
Practice Address - State:GA
Practice Address - Zip Code:30536-2039
Practice Address - Country:US
Practice Address - Phone:706-698-5433
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-08
Last Update Date:2024-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GARN307169363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily