Provider Demographics
NPI:1790487916
Name:MILLER, KELLIE PATCHEN
Entity Type:Individual
Prefix:
First Name:KELLIE
Middle Name:PATCHEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:KELLIE
Other - Middle Name:ANN
Other - Last Name:PATCHEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4949 ROMA AVE NE APT 20
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87108-1375
Mailing Address - Country:US
Mailing Address - Phone:575-631-1787
Mailing Address - Fax:
Practice Address - Street 1:901 RIO GRANDE BLVD NW STE H160
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87104-2063
Practice Address - Country:US
Practice Address - Phone:505-278-0807
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-21
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program