Provider Demographics
NPI:1780660118
Name:MILLER, KELLI A (APRN)
Entity Type:Individual
Prefix:
First Name:KELLI
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4129 MOUNTAIN COVE DR
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28216-7776
Mailing Address - Country:US
Mailing Address - Phone:704-393-3593
Mailing Address - Fax:
Practice Address - Street 1:294 N HIGHWAY 16
Practice Address - Street 2:SUITE A
Practice Address - City:DENVER
Practice Address - State:NC
Practice Address - Zip Code:28037-8011
Practice Address - Country:US
Practice Address - Phone:704-489-2400
Practice Address - Fax:704-489-2900
Is Sole Proprietor?:No
Enumeration Date:2005-12-18
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201950363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC133E0OtherBCBS
NC89133E0Medicaid
NC89133E0Medicaid
NCQ44149Medicare UPIN