Provider Demographics
NPI:1174657415
Name:BROUGHTON-MILLER, KIMBERLY DANA (ARNP, MSN)
Entity Type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:DANA
Last Name:BROUGHTON-MILLER
Suffix:
Gender:F
Credentials:ARNP, MSN
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Other - First Name:
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Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5454 NEW CUT RD
Mailing Address - Street 2:SUITE 5
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40214-4271
Mailing Address - Country:US
Mailing Address - Phone:502-361-9900
Mailing Address - Fax:502-361-9947
Practice Address - Street 1:200 ABRAHAM FLEXNER WAY
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40202-2877
Practice Address - Country:US
Practice Address - Phone:502-587-4421
Practice Address - Fax:502-587-4840
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-16
Last Update Date:2014-04-09
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
KY5132P363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100159710Medicaid
KY7100159710Medicaid