| Doctor Name: | MRS. CARLENE S MCMILLIAN |
| NPI Number: | 1164427324 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | F.N.P. |
| License Number: | 113217 |
| Business Practice Address: | 206 W. 2nd Street Dixon, MO - 654590940 |
| Business Phone Number: | 5737593030 |
| Business Fax Number: | 5737593131 |
| Mailing Address: | P.o. Drawer 9900, DIXON |
| State: | MO |
| Postal Code: | 654590940 |
| Phone Number: | 5737593030 |
| Fax Number: | 5737593131 |
| NPI Enumeration Date: | 06/15/2005 |
| NPI Last Update Date: | 11/06/2009 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 363LF0000X |
| License Number: | 113217 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MO |
| Taxonomy Type: | Physician Assistants & Advanced Practice Nursing Providers |
| Taxonomy Classification: | Nurse Practitioner |
| Taxonomy Specialization: | Family |
| Taxonomy Definition: | |