Provider Demographics
NPI:1437717634
Name:MILLER, KELSEY JARNA
Entity Type:Individual
Prefix:
First Name:KELSEY
Middle Name:JARNA
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:347 RICEVILLE RD
Mailing Address - Street 2:
Mailing Address - City:JAVA
Mailing Address - State:VA
Mailing Address - Zip Code:24565-4101
Mailing Address - Country:US
Mailing Address - Phone:434-770-0049
Mailing Address - Fax:
Practice Address - Street 1:347 RICEVILLE RD
Practice Address - Street 2:
Practice Address - City:JAVA
Practice Address - State:VA
Practice Address - Zip Code:24565-4101
Practice Address - Country:US
Practice Address - Phone:434-770-0049
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-06-03
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDLBA1398103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst