Provider Demographics
NPI:1912296047
Name:MCMILLIN, MARY MURPHY (APN)
Entity type:Individual
Prefix:MRS
First Name:MARY
Middle Name:MURPHY
Last Name:MCMILLIN
Suffix:
Gender:F
Credentials:APN
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Mailing Address - Street 1:PO BOX 400
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38302-0400
Mailing Address - Country:US
Mailing Address - Phone:731-423-8697
Mailing Address - Fax:731-422-5743
Practice Address - Street 1:720 W FOREST AVE
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3904
Practice Address - Country:US
Practice Address - Phone:731-541-9561
Practice Address - Fax:731-541-1829
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-29
Last Update Date:2018-03-15
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
TNAPN15696363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1528948Medicaid
TN103I505848Medicare PIN