Healthcare Provider Details

I. General information

NPI: 1417868225
Provider Name (Legal Business Name): MR. PRESTON RYAN MCMILLIAN II
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/14/2026
Last Update Date: 09/14/2026
Certification Date: 09/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4600 ABBOTT RD
ANCHORAGE AK
99507-4314
US

IV. Provider business mailing address

9975 WILLIAM JONES CIR UNIT 6
ANCHORAGE AK
99515-4263
US

V. Phone/Fax

Practice location:
  • Phone: 907-346-2101
  • Fax:
Mailing address:
  • Phone: 301-712-5229
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateAK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: