Provider Demographics
NPI:1649551797
Name:MILLER, MICHAEL K (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:MICHAEL
Middle Name:K
Last Name:MILLER
Suffix:
Gender:M
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1721 NICHOLASVILLE RD
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40503-1428
Mailing Address - Country:US
Mailing Address - Phone:859-252-6500
Mailing Address - Fax:859-252-3073
Practice Address - Street 1:1721 NICHOLASVILLE RD
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40503-1428
Practice Address - Country:US
Practice Address - Phone:859-252-6500
Practice Address - Fax:859-252-3073
Is Sole Proprietor?:No
Enumeration Date:2011-09-02
Last Update Date:2014-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3007032363LF0000X, 363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYCD2933OtherRR MEDICARE
KYK142801Medicare PIN
KYK142800Medicare PIN