Provider Demographics
NPI:1689161150
Name:MILLER, KENIESHA (MSN, APRN, NP-C)
Entity Type:Individual
Prefix:
First Name:KENIESHA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:MSN, APRN, NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:425 HOLDERRIETH BLVD STE 212
Mailing Address - Street 2:
Mailing Address - City:TOMBALL
Mailing Address - State:TX
Mailing Address - Zip Code:77375-4552
Mailing Address - Country:US
Mailing Address - Phone:281-766-8800
Mailing Address - Fax:281-378-5918
Practice Address - Street 1:425 HOLDERRIETH BLVD
Practice Address - Street 2:SUITE 212
Practice Address - City:TOMBALL
Practice Address - State:TX
Practice Address - Zip Code:77375
Practice Address - Country:US
Practice Address - Phone:281-766-8800
Practice Address - Fax:281-378-5918
Is Sole Proprietor?:No
Enumeration Date:2018-04-19
Last Update Date:2018-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP137150363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner