Basic Information
Provider Information
NPI: 1275860876
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MILBURN
FirstName: KRISTYN
MiddleName: D
NamePrefix:  
NameSuffix:  
Credential: ARNP
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
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OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 3011 N MICHIGAN ST
Address2:  
City: PITTSBURG
State: KS
PostalCode: 667622546
CountryCode: US
TelephoneNumber: 6202319873
FaxNumber:  
Practice Location
Address1: 11155 TUCKER RD
Address2:  
City: PLEASANTON
State: KS
PostalCode: 660758401
CountryCode: US
TelephoneNumber: 9133528379
FaxNumber: 9133528998
Other Information
ProviderEnumerationDate: 11/03/2009
LastUpdateDate: 01/16/2019
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
363L00000X74956KSY Physician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner 

No ID Information.


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