Healthcare Provider Details

I. General information

NPI: 1275860876
Provider Name (Legal Business Name): KRISTYN D MILBURN ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/03/2009
Last Update Date: 01/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11155 TUCKER RD
PLEASANTON KS
66075-8401
US

IV. Provider business mailing address

3011 N MICHIGAN ST
PITTSBURG KS
66762-2546
US

V. Phone/Fax

Practice location:
  • Phone: 913-352-8379
  • Fax: 913-352-8998
Mailing address:
  • Phone: 620-231-9873
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number74956
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: