=====================================================
General NPI Number Information
=====================================================
NPI Number | 1477847515
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | KIMBERLY LARNELL MILLIGAN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/07/2011
-----------------------------------------------------
Last Update Date | 11/17/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1205 4TH ST
-----------------------------------------------------
City | KEY WEST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33040-3707
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 305-434-7660
-----------------------------------------------------
Fax | 305-292-6723
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2043 HALSEY DR
-----------------------------------------------------
City | KEY WEST
-----------------------------------------------------
State | FL
-----------------------------------------------------
Zip | 33040-7077
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 757-289-8997
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 171M00000X
-----------------------------------------------------
Taxonomy Name | Case Manager/Care Coordinator
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------