Provider Demographics
NPI:1518118074
Name:MILLER, KERRY (RN)
Entity Type:Individual
Prefix:
First Name:KERRY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:411 MAIN ST FL 3
Mailing Address - Street 2:
Mailing Address - City:CATSKILL
Mailing Address - State:NY
Mailing Address - Zip Code:12414-1363
Mailing Address - Country:US
Mailing Address - Phone:518-719-3600
Mailing Address - Fax:519-719-3799
Practice Address - Street 1:411 MAIN ST FL 3
Practice Address - Street 2:
Practice Address - City:CATSKILL
Practice Address - State:NY
Practice Address - Zip Code:12414-1363
Practice Address - Country:US
Practice Address - Phone:518-719-3600
Practice Address - Fax:519-719-3799
Is Sole Proprietor?:No
Enumeration Date:2008-10-02
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY445905-1163W00000X, 163WC1500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WC1500XNursing Service ProvidersRegistered NurseCommunity Health
No163W00000XNursing Service ProvidersRegistered Nurse
Provider Identifiers
StateIdentifier IDID TypeIssuer
NY00473230Medicaid
NY337050OtherMEDICARE