Provider Demographics
NPI:1982204327
Name:MILLER, KEVIN D
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:D
Last Name:MILLER
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4429 SAHARA PL
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76115-3653
Mailing Address - Country:US
Mailing Address - Phone:817-903-6190
Mailing Address - Fax:
Practice Address - Street 1:4429 SAHARA PL
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76115-3653
Practice Address - Country:US
Practice Address - Phone:817-903-6190
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-10-26
Last Update Date:2020-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health