Provider Demographics
NPI:1174952022
Name:MILLER, KIMBERLY K (CNM)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:K
Last Name:MILLER
Suffix:
Gender:F
Credentials:CNM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:921 JASONWAY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43214-2456
Mailing Address - Country:US
Mailing Address - Phone:614-268-8800
Mailing Address - Fax:614-447-8876
Practice Address - Street 1:921 JASONWAY AVE STE B
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43214-2456
Practice Address - Country:US
Practice Address - Phone:614-268-8800
Practice Address - Fax:614-447-8876
Is Sole Proprietor?:No
Enumeration Date:2013-11-01
Last Update Date:2023-01-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH15197367A00000X
OHAPRN.CNM.15197367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0093537Medicaid