Individual
KENNETH L MILLSAP
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
NP
Contact information
Practice address
520 MEDICAL CENTER DR, SUITE 201, MEDFORD, OR 97504-4334
(541) 789-5710
(541) 789-5711
Mailing address
2620 E BARNETT RD, SUITE H, MEDFORD, OR 97504-8344
(541) 789-5250
Taxonomy
Speciality
Code
Description
License number
State
363LF0000X
Family Nurse Practitioner
Primary
200450110NPFNP-PP
OR
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
292119
—
OR
Enumeration date
07/27/2006
Last updated
03/19/2015
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