Provider Demographics
NPI:1972017416
Name:MILLER, KATRINA LEANNE (APRN-WHNP)
Entity Type:Individual
Prefix:
First Name:KATRINA
Middle Name:LEANNE
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN-WHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6738 STATE HIGHWAY 77
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:MO
Mailing Address - Zip Code:63736-8238
Mailing Address - Country:US
Mailing Address - Phone:573-313-2500
Mailing Address - Fax:573-313-2505
Practice Address - Street 1:741 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:BERNIE
Practice Address - State:MO
Practice Address - Zip Code:63822-8900
Practice Address - Country:US
Practice Address - Phone:573-293-6836
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-20
Last Update Date:2020-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019010518363LW0102X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LW0102XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerWomen's Health