Provider Demographics
NPI:1093094674
Name:MILLER CAROLAN, GRETCHEN ELIZABETH (APRN)
Entity Type:Individual
Prefix:
First Name:GRETCHEN
Middle Name:ELIZABETH
Last Name:MILLER CAROLAN
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:GRETCHEN
Other - Middle Name:E
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:PO BOX 909
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40201-0909
Mailing Address - Country:US
Mailing Address - Phone:502-561-8844
Mailing Address - Fax:502-561-8843
Practice Address - Street 1:550 S JACKSON ST FL 2
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-1622
Practice Address - Country:US
Practice Address - Phone:502-561-8844
Practice Address - Fax:502-561-8843
Is Sole Proprietor?:No
Enumeration Date:2011-08-12
Last Update Date:2020-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3006908363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN201167510Medicaid
KY7100183270Medicaid
IN201167510Medicaid
KYK058290Medicare PIN