Provider Demographics
NPI:1497200919
Name:DONNAMILLER, KALEIGH (NP-C)
Entity Type:Individual
Prefix:
First Name:KALEIGH
Middle Name:
Last Name:DONNAMILLER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:315 CRESTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:WILLARD
Mailing Address - State:OH
Mailing Address - Zip Code:44890-1652
Mailing Address - Country:US
Mailing Address - Phone:419-935-0196
Mailing Address - Fax:419-933-7616
Practice Address - Street 1:315 CRESTWOOD DR
Practice Address - Street 2:
Practice Address - City:WILLARD
Practice Address - State:OH
Practice Address - Zip Code:44890-1652
Practice Address - Country:US
Practice Address - Phone:419-935-0196
Practice Address - Fax:419-933-7616
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-25
Last Update Date:2017-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019506363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH0181869Medicaid
OHH497130Medicare PIN