Provider Demographics
NPI:1316302409
Name:MILBURN, KRISTEN (PMHNP)
Entity type:Individual
Prefix:
First Name:KRISTEN
Middle Name:
Last Name:MILBURN
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 OSWEGO ST
Mailing Address - Street 2:SUITE 1
Mailing Address - City:LIVERPOOL
Mailing Address - State:NY
Mailing Address - Zip Code:13088-5178
Mailing Address - Country:US
Mailing Address - Phone:315-883-5737
Mailing Address - Fax:
Practice Address - Street 1:600 OSWEGO ST
Practice Address - Street 2:SUITE 1
Practice Address - City:LIVERPOOL
Practice Address - State:NY
Practice Address - Zip Code:13088-5178
Practice Address - Country:US
Practice Address - Phone:315-883-5737
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF401835363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health