Provider Demographics
NPI:1255668760
Name:MILLER, KAITLIN HARRIS (NP)
Entity Type:Individual
Prefix:MRS
First Name:KAITLIN
Middle Name:HARRIS
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:PO BOX 13030
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:LA
Mailing Address - Zip Code:71315-3030
Mailing Address - Country:US
Mailing Address - Phone:318-445-9331
Mailing Address - Fax:318-619-6899
Practice Address - Street 1:176 VERSAILLES BLVD
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:LA
Practice Address - Zip Code:71303-2493
Practice Address - Country:US
Practice Address - Phone:318-445-9331
Practice Address - Fax:318-619-6899
Is Sole Proprietor?:No
Enumeration Date:2009-11-05
Last Update Date:2020-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LATAP002208363LA2200X
LAAP06082363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1811297Medicaid