Provider Demographics
NPI:1811023500
Name:MILLER, KAREN L (PA-C)
Entity Type:Individual
Prefix:MS
First Name:KAREN
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1028 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:YANKTON
Mailing Address - State:SD
Mailing Address - Zip Code:57078-2910
Mailing Address - Country:US
Mailing Address - Phone:605-665-4606
Mailing Address - Fax:
Practice Address - Street 1:1028 WALNUT ST
Practice Address - Street 2:
Practice Address - City:YANKTON
Practice Address - State:SD
Practice Address - Zip Code:57078-2910
Practice Address - Country:US
Practice Address - Phone:605-665-4606
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-26
Last Update Date:2016-11-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD0234363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
SDR82576Medicare UPIN
SD3791Medicare ID - Type UnspecifiedMEDICARE #