Active NPI
Kathy Moore Millard, RN
- Registered Nurse
- Watertown, NY
National Provider Identifier
1972054997
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Registered Nurse
- License
- 533385
- Practice address
- 482 Black River Pkwy
Watertown, NY 13601-2416 - Phone
- (315) 782-1777
- Fax
- (315) 785-8628
- NPI assigned
- Oct 14, 2016
- Sex
- Female
- 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 |
|---|---|---|---|---|
| Registered Nurse | 163W00000X | 533385 | NY | Primary |
Addresses
Primary practice location
482 Black River Pkwy
Watertown, NY 13601-2416
Mailing address
7550 S State St
Lowville, NY 13367-1574
Phone (315) 376-5450
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
- Credentials
- Registered Nurse
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 533385 | NY | MD | Registered Nurse |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Thrive Wellness and Recovery, Inc | Past | Accepting new patients | |
| North Country Transitional Living Services, Inc | Past | Accepting new patients |
Organizations & group practices 2
Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.
-
- Mental Illness Community Based Residential Treatment Facility
- Watertown, NY
- NPI 1538294699
-
- Substance Use Disorder Rehabilitation Clinic/Center
- Watertown, NY
- NPI 1659389021
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1476403200000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1476403200000",
"number": "1972054997",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "7550 S STATE ST",
"city": "LOWVILLE",
"state": "NY",
"postal_code": "133671574",
"telephone_number": "315-376-5450",
"fax_number": "315-376-7221"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "482 BLACK RIVER PKWY",
"city": "WATERTOWN",
"state": "NY",
"postal_code": "136012416",
"telephone_number": "315-782-1777",
"fax_number": "315-785-8628"
}
],
"practiceLocations": [],
"basic": {
"last_name": "MILLARD",
"first_name": "KATHY",
"middle_name": "MOORE",
"credential": "RN",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2016-10-14",
"last_updated": "2016-10-14",
"status": "A"
},
"taxonomies": [
{
"code": "163W00000X",
"taxonomy_group": "",
"desc": "Registered Nurse",
"state": "NY",
"license": "533385",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}
Other providers in Watertown, NY
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 14, 2016; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.