Provider Demographics
NPI:1164968749
Name:MILLER, KELLI JO (FNP-C)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:JO
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 1:165 UNIVERSITY DR
Mailing Address - Street 2:
Mailing Address - City:AMHERST
Mailing Address - State:MA
Mailing Address - Zip Code:01002-8900
Mailing Address - Country:US
Mailing Address - Phone:682-331-9534
Mailing Address - Fax:
Practice Address - Street 1:173 S MAIN ST
Practice Address - Street 2:
Practice Address - City:RUTLAND
Practice Address - State:VT
Practice Address - Zip Code:05701-4713
Practice Address - Country:US
Practice Address - Phone:802-772-4165
Practice Address - Fax:802-855-8489
Is Sole Proprietor?:No
Enumeration Date:2017-01-06
Last Update Date:2023-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VT101.0134229363LF0000X
TXAP132850363LF0000X, 363LP2300X
ME221431363LP2300X
COAPN.0995662363LP2300X
MA2345722363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care