Individual provider Active NPI

Kathy Moore Millard, RN

  • Registered Nurse
  • Watertown, NY
National Provider Identifier
1972054997
Registry record updated Oct 14, 2016
On this page

Key facts

NPPES NPI Registry
Primary specialty
Registered NurseTaxonomy code 163W00000X
License
533385 Issued in NY
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

Updated by the provider on Oct 14, 2016

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
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

LicenseStateTypeSpecialty
533385NYMDRegistered Nurse

Practice roles

OrganizationSpecialtyStatusNew patients
Thrive Wellness and Recovery, Inc PastSince Aug 4, 2024 Accepting new patients
North Country Transitional Living Services, Inc PastSince Jul 1, 2019 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.

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.

Verify at the official NPI Registry.