Basic Information
| Provider Information | |||||||||
| NPI: | 1083247613 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCMILLEN | ||||||||
| FirstName: | KAYLA | ||||||||
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| Credential: | AGPCNP-BC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12900 PARK PLAZA DR STE 150 | ||||||||
| Address2: | |||||||||
| City: | CERRITOS | ||||||||
| State: | CA | ||||||||
| PostalCode: | 907039329 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5626772409 | ||||||||
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| Practice Location | |||||||||
| Address1: | 3041 E FLAMINGO RD STE A | ||||||||
| Address2: | |||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891217447 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7024360835 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 02/21/2020 | ||||||||
| LastUpdateDate: | 03/19/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 03/19/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207QA0505X | 815197 | NV | N | Allopathic & Osteopathic Physicians | Family Medicine | Adult Medicine | 207QG0300X | 815197 | NV | N | Allopathic & Osteopathic Physicians | Family Medicine | Geriatric Medicine | 363LF0000X | 815197 | NV | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.