Healthcare Provider Details

I. General information

NPI: 1033360102
Provider Name (Legal Business Name): KATHRYN MILLARD PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/07/2008
Last Update Date: 09/25/2023
Certification Date: 09/25/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2101 SPRUCE ST
NORTH COLLINS NY
14111-9701
US

IV. Provider business mailing address

1791 HUBBARD RD
EAST AURORA NY
14052-3031
US

V. Phone/Fax

Practice location:
  • Phone: 716-337-3706
  • Fax:
Mailing address:
  • Phone: 716-512-9520
  • Fax: 716-822-8165

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License NumberF401136
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: