Provider Demographics
NPI:1053541672
Name:MCMILLIN, KELLY L (MD)
Entity type:Individual
Prefix:
First Name:KELLY
Middle Name:L
Last Name:MCMILLIN
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
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Mailing Address - Street 1:709 WEST 8TH STREET
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82716
Mailing Address - Country:US
Mailing Address - Phone:307-682-3333
Mailing Address - Fax:307-682-6723
Practice Address - Street 1:709 W 8TH ST
Practice Address - Street 2:SUITE 4
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82716-4125
Practice Address - Country:US
Practice Address - Phone:307-682-3333
Practice Address - Fax:307-682-6723
Is Sole Proprietor?:No
Enumeration Date:2009-07-16
Last Update Date:2012-12-07
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
WY8200A207Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine