Active NPI
Kamren Millsap
- Physical Therapy Assistant
- Waco, TX
National Provider Identifier
1366924367
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Physical Therapy Assistant
- License
- 2113893
- Practice address
- 2320 Lake Shore Dr
Waco, TX 76708-1276 - Phone
- (254) 752-1075
- NPI assigned
- Sep 5, 2018
- Sex
- Male
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Physical Therapy Assistant | 225200000X | 2113893 | Primary |
Addresses
Primary practice location
2320 Lake Shore Dr
Waco, TX 76708-1276
Mailing address
6501 Sydney Dr
Waco, TX 76708-5311
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1536105600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1536105600000",
"number": "1366924367",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "6501 SYDNEY DR",
"city": "WACO",
"state": "TX",
"postal_code": "767085311"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2320 LAKE SHORE DR",
"city": "WACO",
"state": "TX",
"postal_code": "767081276",
"telephone_number": "254-752-1075"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLSAP",
"first_name": "KAMREN",
"sole_proprietor": "NO",
"sex": "M",
"enumeration_date": "2018-09-05",
"last_updated": "2018-09-05",
"status": "A"
},
"taxonomies": [
{
"code": "225200000X",
"taxonomy_group": "",
"desc": "Physical Therapy Assistant",
"state": null,
"license": "2113893",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Waco, TX
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 5, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.