Provider Demographics
NPI:1245911122
Name:MILLER, KENNETH (MSN, AGCNS-BC, OCN)
Entity type:Individual
Prefix:MR
First Name:KENNETH
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:MSN, AGCNS-BC, OCN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:757 OLD CASTLE DR
Mailing Address - Street 2:
Mailing Address - City:RANDLEMAN
Mailing Address - State:NC
Mailing Address - Zip Code:27317-8234
Mailing Address - Country:US
Mailing Address - Phone:336-460-1433
Mailing Address - Fax:
Practice Address - Street 1:2400 W FRIENDLY AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27403-1109
Practice Address - Country:US
Practice Address - Phone:336-832-1288
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-07-25
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC572364S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364S00000XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse Specialist