Provider Demographics
NPI:1013975473
Name:MILLER, DAVID KIRK (PHD)
Entity Type:Individual
Prefix:
First Name:DAVID
Middle Name:KIRK
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:DANA
Other - Middle Name:KIRK
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PHD
Mailing Address - Street 1:833 N WACO
Mailing Address - Street 2:SUITE 200
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67203-3939
Mailing Address - Country:US
Mailing Address - Phone:316-263-2351
Mailing Address - Fax:316-263-3685
Practice Address - Street 1:833 N WACO
Practice Address - Street 2:SUITE 200
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67203-3939
Practice Address - Country:US
Practice Address - Phone:316-263-2351
Practice Address - Fax:316-263-3685
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-03
Last Update Date:2008-05-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS634103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS013316OtherBCBS
KS100240980BMedicaid
R80720Medicare UPIN
KS013316Medicare ID - Type Unspecified