Provider Demographics
NPI:1346562485
Name:MILLER, VANESSA DAWN (NP-C)
Entity Type:Individual
Prefix:MRS
First Name:VANESSA
Middle Name:DAWN
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:MISS
Other - First Name:VANESSA
Other - Middle Name:DAWN
Other - Last Name:GREENE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:NP-C
Mailing Address - Street 1:525 MARSAILLES RD
Mailing Address - Street 2:
Mailing Address - City:VERSAILLES
Mailing Address - State:KY
Mailing Address - Zip Code:40383-1911
Mailing Address - Country:US
Mailing Address - Phone:859-297-1072
Mailing Address - Fax:
Practice Address - Street 1:525 MARSAILLES RD
Practice Address - Street 2:
Practice Address - City:VERSAILLES
Practice Address - State:KY
Practice Address - Zip Code:40383-1911
Practice Address - Country:US
Practice Address - Phone:859-297-1072
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-16
Last Update Date:2014-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1107307163W00000X
KY3006241363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse