Provider Demographics
NPI:1003569724
Name:KIRA MILLER NUTRITION & WELLNESS
Entity Type:Organization
Organization Name:KIRA MILLER NUTRITION & WELLNESS
Other - Org Name:KIRA MILLER NUTRITION & WELLNESS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIRA
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:MS, RDN, LD
Authorized Official - Phone:469-398-3223
Mailing Address - Street 1:1103 ELM GROVE DR
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75002-1107
Mailing Address - Country:US
Mailing Address - Phone:469-398-3223
Mailing Address - Fax:469-331-7063
Practice Address - Street 1:450 CENTURY PKWY STE 250
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-8136
Practice Address - Country:US
Practice Address - Phone:469-398-3223
Practice Address - Fax:469-331-7063
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-02
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX86079155OtherCDR
TXDT85736OtherTDLR