Provider Demographics
NPI:1710550611
Name:MILLER, KRISTINA (CPNP)
Entity Type:Individual
Prefix:
First Name:KRISTINA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:CPNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6353 2ND ST
Mailing Address - Street 2:
Mailing Address - City:WILMER
Mailing Address - State:AL
Mailing Address - Zip Code:36587-4453
Mailing Address - Country:US
Mailing Address - Phone:251-410-7425
Mailing Address - Fax:251-649-6200
Practice Address - Street 1:6353 2ND ST
Practice Address - Street 2:
Practice Address - City:WILMER
Practice Address - State:AL
Practice Address - Zip Code:36587-4453
Practice Address - Country:US
Practice Address - Phone:251-410-7425
Practice Address - Fax:251-649-6200
Is Sole Proprietor?:No
Enumeration Date:2021-07-20
Last Update Date:2021-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-113092363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care