Provider Demographics
NPI:1134298276
Name:MILLER, KIMBERLY DAWN (FNP-C)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:DAWN
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 REID PKWY
Mailing Address - Street 2:MEDICAL STAFF SERVICES
Mailing Address - City:RICHMOND
Mailing Address - State:IN
Mailing Address - Zip Code:47374-1157
Mailing Address - Country:US
Mailing Address - Phone:765-489-3935
Mailing Address - Fax:765-489-6344
Practice Address - Street 1:4829 N STATE ROAD 1
Practice Address - Street 2:HAGERSTOWN FAMILY PRACTICE
Practice Address - City:HAGERSTOWN
Practice Address - State:IN
Practice Address - Zip Code:47346-9620
Practice Address - Country:US
Practice Address - Phone:765-489-3935
Practice Address - Fax:765-489-6344
Is Sole Proprietor?:No
Enumeration Date:2006-11-06
Last Update Date:2021-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN71005072A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN000001012297OtherANTHEM
IN201251010Medicaid
IN202020008Medicare PIN
IN256480029Medicare PIN
IN201251010Medicaid