=====================================================
General NPI Number Information
=====================================================
NPI Number | 1164385159
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIERSTYN MCMILLEN ATC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/05/2025
-----------------------------------------------------
Last Update Date | 12/05/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1600 CAMPUS CT
-----------------------------------------------------
City | ABILENE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 79601-3761
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 325-674-2000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 719 N ELM ST
-----------------------------------------------------
City | STANBERRY
-----------------------------------------------------
State | MO
-----------------------------------------------------
Zip | 64489-1030
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 2255A2300X
-----------------------------------------------------
Taxonomy Name | Athletic Trainer
-----------------------------------------------------
License Number | AT10171
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------