Provider Demographics
NPI:1467088096
Name:MILLER, KELSI MARIE (CRNA)
Entity Type:Individual
Prefix:
First Name:KELSI
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:KELSI
Other - Middle Name:MARIE
Other - Last Name:BURNETT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:3201 CHELSEA PL
Mailing Address - Street 2:
Mailing Address - City:MIDLAND
Mailing Address - State:TX
Mailing Address - Zip Code:79705-2324
Mailing Address - Country:US
Mailing Address - Phone:903-818-1421
Mailing Address - Fax:
Practice Address - Street 1:600 E. INTERSTATE 20
Practice Address - Street 2:
Practice Address - City:STANTON
Practice Address - State:TX
Practice Address - Zip Code:79782
Practice Address - Country:US
Practice Address - Phone:432-607-3200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-03-16
Last Update Date:2020-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP145505367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered