Provider Demographics
NPI:1740221738
Name:MILLER-ANDERSEN, KATHLEEN G (APRN, PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:KATHLEEN
Middle Name:G
Last Name:MILLER-ANDERSEN
Suffix:
Gender:F
Credentials:APRN, PMHNP-BC
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:G
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN, PMHNP-BC
Mailing Address - Street 1:2814 S BEVERLY ST
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84106-3125
Mailing Address - Country:US
Mailing Address - Phone:801-608-7392
Mailing Address - Fax:
Practice Address - Street 1:409 W 400 S
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84101-1135
Practice Address - Country:US
Practice Address - Phone:801-364-0058
Practice Address - Fax:801-364-0161
Is Sole Proprietor?:No
Enumeration Date:2006-06-09
Last Update Date:2022-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT221622-4405363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner