Provider Demographics
NPI:1336432103
Name:MILLER, KIMBERLY JANE (DO)
Entity Type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:JANE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DO
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6855 W CLEARWATER AVE STE A101-142
Mailing Address - Street 2:
Mailing Address - City:KENNEWICK
Mailing Address - State:WA
Mailing Address - Zip Code:99336-5011
Mailing Address - Country:US
Mailing Address - Phone:509-980-1591
Mailing Address - Fax:
Practice Address - Street 1:294 PIPER ST
Practice Address - Street 2:
Practice Address - City:RICHLAND
Practice Address - State:WA
Practice Address - Zip Code:99352-8703
Practice Address - Country:US
Practice Address - Phone:509-980-1591
Practice Address - Fax:509-350-4888
Is Sole Proprietor?:Yes
Enumeration Date:2011-05-26
Last Update Date:2021-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAOT014300207Q00000X
WAOP60546764207QG0300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QG0300XAllopathic & Osteopathic PhysiciansFamily MedicineGeriatric Medicine
No207Q00000XAllopathic & Osteopathic PhysiciansFamily Medicine