MEDICARE: MRS. ROBIN S MCMILLAN FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	APN0000012180	TN

General Provider Information

NPI Number	:	1184604852
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. ROBIN S MCMILLAN FNP

Provider Business Mailing Address
First Line	:	130 W. RAVINE ST.
Second Line	:	SUITE 9-I
City	:	KINGSPORT
State	:	TN
Zip	:	37660-3837
Country	:	US
Telephone Number	:	423-224-5699
Fax Number	:

Provider Business Practice Location Address
First Line	:	146 WEST PARK DRIVE, SUITE 9-I
Second Line	:
City	:	KINGSPORT
State	:	TN
Zip	:	37660-3835
Country	:	US
Telephone Number	:	423-224-5699
Fax Number	:	423-224-4974

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/19/2006
Last Update Date	:	08/06/2012

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