Provider Demographics
NPI:1598544066
Name:KIDS KLINIC, LLC
Entity Type:Organization
Organization Name:KIDS KLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:MRS
Authorized Official - First Name:LINDSAY
Authorized Official - Middle Name:RENAE
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP
Authorized Official - Phone:256-558-2636
Mailing Address - Street 1:111 COUNTY ROAD 208
Mailing Address - Street 2:
Mailing Address - City:BOAZ
Mailing Address - State:AL
Mailing Address - Zip Code:35957-7603
Mailing Address - Country:US
Mailing Address - Phone:256-558-2636
Mailing Address - Fax:
Practice Address - Street 1:3683 US HIGHWAY 431
Practice Address - Street 2:
Practice Address - City:ALBERTVILLE
Practice Address - State:AL
Practice Address - Zip Code:35950-0240
Practice Address - Country:US
Practice Address - Phone:256-849-0436
Practice Address - Fax:256-849-0769
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-25
Last Update Date:2023-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Single Specialty