Provider Demographics
NPI:1366044323
Name:MILLER, KELSEY ELIZABETH (APRN, FNP-C)
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:969 COOPER LN
Mailing Address - Street 2:
Mailing Address - City:PROCTOR
Mailing Address - State:WV
Mailing Address - Zip Code:26055-1424
Mailing Address - Country:US
Mailing Address - Phone:304-771-8264
Mailing Address - Fax:
Practice Address - Street 1:10 MEDICAL PARK STE 300
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-6389
Practice Address - Country:US
Practice Address - Phone:304-242-3900
Practice Address - Fax:304-242-8564
Is Sole Proprietor?:No
Enumeration Date:2020-11-13
Last Update Date:2020-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV107141363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily