Provider Demographics
NPI:1235289018
Name:MILLER, KATHRYN S (NP)
Entity Type:Individual
Prefix:
First Name:KATHRYN
Middle Name:S
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3706 S 1ST ST
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78704-7046
Mailing Address - Country:US
Mailing Address - Phone:512-324-4973
Mailing Address - Fax:512-324-4948
Practice Address - Street 1:8913 COLLINFIELD DR
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78758-6704
Practice Address - Country:US
Practice Address - Phone:512-324-6850
Practice Address - Fax:512-324-6851
Is Sole Proprietor?:No
Enumeration Date:2007-01-12
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX698579363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX111433201OtherEPSDT MEDICAID