Provider Demographics
NPI:1639136732
Name:MILKS, DEBORAH (CNP)
Entity Type:Individual
Prefix:
First Name:DEBORAH
Middle Name:
Last Name:MILKS
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:660 ACKERMAN 3RD FLOOR
Mailing Address - Street 2:PO BOX 183103
Mailing Address - City:COLUMBUS
Mailing Address - State:OH
Mailing Address - Zip Code:43218-3108
Mailing Address - Country:US
Mailing Address - Phone:614-293-2150
Mailing Address - Fax:614-293-6479
Practice Address - Street 1:153 WEST MAIN STREET
Practice Address - Street 2:SUITE 100
Practice Address - City:NEW ALBANY
Practice Address - State:OH
Practice Address - Zip Code:43054
Practice Address - Country:US
Practice Address - Phone:614-293-2293
Practice Address - Fax:614-293-2294
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHRN138323363L00000X
OH03154363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2196949Medicaid
OH2196949Medicaid
NP04037Medicare ID - Type Unspecified