Provider Demographics
NPI:1962479170
Name:MILLER DERAJTYS, K. PATRICIA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:K. PATRICIA
Middle Name:
Last Name:MILLER DERAJTYS
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:KATHLEEN
Other - Middle Name:PATRICIA
Other - Last Name:DERAJTYS
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:FNP
Mailing Address - Street 1:1278 N LAFAYETTE DR
Mailing Address - Street 2:
Mailing Address - City:SUMTER
Mailing Address - State:SC
Mailing Address - Zip Code:29150-2964
Mailing Address - Country:US
Mailing Address - Phone:803-774-4500
Mailing Address - Fax:803-774-4641
Practice Address - Street 1:1278 N LAFAYETTE DRIVE
Practice Address - Street 2:
Practice Address - City:SUMTER
Practice Address - State:SC
Practice Address - Zip Code:29150
Practice Address - Country:US
Practice Address - Phone:803-774-4500
Practice Address - Fax:803-774-4641
Is Sole Proprietor?:No
Enumeration Date:2006-03-07
Last Update Date:2013-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC236363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
SCNP0840Medicaid
SCAA06522603Medicare PIN
Q25898Medicare UPIN