Provider Demographics
NPI:1457543951
Name:MILLER, KARA NICOLE (PA)
Entity Type:Individual
Prefix:
First Name:KARA
Middle Name:NICOLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2600 N. LIMESTONE
Mailing Address - Street 2:2ND FLOOR
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OH
Mailing Address - Zip Code:45503
Mailing Address - Country:US
Mailing Address - Phone:937-523-9850
Mailing Address - Fax:937-523-9859
Practice Address - Street 1:2600 N. LIMESTONE
Practice Address - Street 2:2ND FLOOR
Practice Address - City:SPRINGFIELD
Practice Address - State:OH
Practice Address - Zip Code:45503
Practice Address - Country:US
Practice Address - Phone:937-523-9850
Practice Address - Fax:937-523-9859
Is Sole Proprietor?:No
Enumeration Date:2007-08-17
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH50.002639363AS0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AS0400XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantSurgical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OHH108680OtherMEDICARE PTAN
OH0075466Medicaid
OHH108681OtherMEDICARE PTAN
OH0075466Medicaid