Provider Demographics
NPI:1124591318
Name:MILLER, TYLER D (APRN)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:D
Last Name:MILLER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 645996
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45264-5996
Mailing Address - Country:US
Mailing Address - Phone:270-651-4444
Mailing Address - Fax:270-651-4892
Practice Address - Street 1:106 COLUMNS PLAZA DR
Practice Address - Street 2:
Practice Address - City:GLASGOW
Practice Address - State:KY
Practice Address - Zip Code:42141-8068
Practice Address - Country:US
Practice Address - Phone:270-651-9390
Practice Address - Fax:270-651-8698
Is Sole Proprietor?:No
Enumeration Date:2019-01-10
Last Update Date:2023-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012741363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily