Basic Information
| Provider Information | |||||||||
| NPI: | 1265584403 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MCMILLIN | ||||||||
| FirstName: | CYNTHIA | ||||||||
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| Credential: | ARNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8911 E ORME ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672072423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166867884 | ||||||||
| FaxNumber: | 3166860036 | ||||||||
| Practice Location | |||||||||
| Address1: | 8911 E ORME ST | ||||||||
| Address2: | SUITE A | ||||||||
| City: | WICHITA | ||||||||
| State: | KS | ||||||||
| PostalCode: | 672072423 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3166867884 | ||||||||
| FaxNumber: | 3166860036 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/17/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WP0807X | 1377757012 | KS | X | Nursing Service Providers | Registered Nurse | Psych/Mental Health, Child & Adolescent | 363LP0808X | 74806 | KS | X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psych/Mental Health |
No ID Information.