Provider Demographics
NPI:1295721397
Name:MILLER-FIKE, DEBRA D (CFNP)
Entity type:Individual
Prefix:MRS
First Name:DEBRA
Middle Name:D
Last Name:MILLER-FIKE
Suffix:
Gender:F
Credentials:CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 N PRICE ST
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:WV
Mailing Address - Zip Code:26537-1120
Mailing Address - Country:US
Mailing Address - Phone:304-329-3500
Mailing Address - Fax:304-329-2088
Practice Address - Street 1:110 N PRICE ST
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:WV
Practice Address - Zip Code:26537-1120
Practice Address - Country:US
Practice Address - Phone:304-329-3500
Practice Address - Fax:304-329-2088
Is Sole Proprietor?:No
Enumeration Date:2005-09-23
Last Update Date:2009-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV41176363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
WV0166872000Medicaid
S58241Medicare UPIN
WVMINP01022Medicare ID - Type Unspecified