Provider Demographics
NPI:1013464080
Name:MILLER, KRISTIE ELIZABETH (NP-C)
Entity Type:Individual
Prefix:
First Name:KRISTIE
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:452 BROADWAY AVE
Mailing Address - Street 2:
Mailing Address - City:YOUNGSTOWN
Mailing Address - State:OH
Mailing Address - Zip Code:44504-1556
Mailing Address - Country:US
Mailing Address - Phone:330-480-2866
Mailing Address - Fax:330-480-4084
Practice Address - Street 1:452 BROADWAY AVE
Practice Address - Street 2:
Practice Address - City:YOUNGSTOWN
Practice Address - State:OH
Practice Address - Zip Code:44504-1556
Practice Address - Country:US
Practice Address - Phone:330-480-2866
Practice Address - Fax:330-480-4084
Is Sole Proprietor?:No
Enumeration Date:2016-09-07
Last Update Date:2024-01-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPRN.CNP.019601363LA2200X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult Health