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Individual
KAYLENE LARISSA MILLARD
Active
Individual
KAYLENE LARISSA MILLARD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
001003569
NC
363A00000X
Physician Assistant
0170981
NY
363A00000X
Physician Assistant
Primary
C0009459
MD
363A00000X
Physician Assistant
PA200001994
DC
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
9667
—
NC
01
—
NC7007A
MEDICARE PTAN
—
Enumeration date
06/11/2012
Last updated
09/12/2024
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