Provider Demographics
NPI:1700521929
Name:MILLER, KEVIN ARTHUR (LVN)
Entity Type:Individual
Prefix:
First Name:KEVIN
Middle Name:ARTHUR
Last Name:MILLER
Suffix:
Gender:M
Credentials:LVN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:52280 AVEINDA MADERO
Mailing Address - Street 2:
Mailing Address - City:LA QUINTA
Mailing Address - State:CA
Mailing Address - Zip Code:92253
Mailing Address - Country:US
Mailing Address - Phone:760-600-0931
Mailing Address - Fax:
Practice Address - Street 1:1330 N INDIAN CANYON DR STE A
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4880
Practice Address - Country:US
Practice Address - Phone:760-537-4779
Practice Address - Fax:760-322-8916
Is Sole Proprietor?:No
Enumeration Date:2022-05-02
Last Update Date:2022-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA717676164X00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes164X00000XNursing Service ProvidersLicensed Vocational Nurse