Provider Demographics
NPI:1053492686
Name:MILLER, HOLLY B (PA-C)
Entity Type:Individual
Prefix:MRS
First Name:HOLLY
Middle Name:B
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:511 WOOSTER ST
Mailing Address - Street 2:
Mailing Address - City:MARIETTA
Mailing Address - State:OH
Mailing Address - Zip Code:45750-1927
Mailing Address - Country:US
Mailing Address - Phone:843-513-4316
Mailing Address - Fax:
Practice Address - Street 1:1049B ANNA KNAPP BLVD
Practice Address - Street 2:
Practice Address - City:MT PLEASANT
Practice Address - State:SC
Practice Address - Zip Code:29464-3133
Practice Address - Country:US
Practice Address - Phone:843-822-0551
Practice Address - Fax:843-849-8889
Is Sole Proprietor?:No
Enumeration Date:2006-10-18
Last Update Date:2024-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC1118363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC0537PAMedicaid