Provider Demographics
NPI:1245548999
Name:MILLER, KIMBERLY DIANE (AUD)
Entity type:Individual
Prefix:DR
First Name:KIMBERLY
Middle Name:DIANE
Last Name:MILLER
Suffix:
Gender:F
Credentials:AUD
Other - Prefix:MISS
Other - First Name:KIMBERLY
Other - Middle Name:DIANE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:AUD
Mailing Address - Street 1:PO BOX 60447
Mailing Address - Street 2:
Mailing Address - City:CHARLOTTE
Mailing Address - State:NC
Mailing Address - Zip Code:28260-0447
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6324 FAIRVIEW RD STE 202
Practice Address - Street 2:
Practice Address - City:CHARLOTTE
Practice Address - State:NC
Practice Address - Zip Code:28210-3361
Practice Address - Country:US
Practice Address - Phone:980-302-9740
Practice Address - Fax:980-302-9750
Is Sole Proprietor?:No
Enumeration Date:2010-09-15
Last Update Date:2024-11-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
237600000X
NC14205231H00000X
TX80312237600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
No237600000XSpeech, Language and Hearing Service ProvidersAudiologist-Hearing Aid Fitter