Provider Demographics
NPI:1700880523
Name:MILLER, KENNETH PETER (PHD, RN, CFNP)
Entity Type:Individual
Prefix:DR
First Name:KENNETH
Middle Name:PETER
Last Name:MILLER
Suffix:
Gender:M
Credentials:PHD, RN, CFNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:943 ALEXANDRIA DR
Mailing Address - Street 2:
Mailing Address - City:NEWARK
Mailing Address - State:DE
Mailing Address - Zip Code:19711-7711
Mailing Address - Country:US
Mailing Address - Phone:302-368-2429
Mailing Address - Fax:
Practice Address - Street 1:27 MARROWS RD
Practice Address - Street 2:
Practice Address - City:NEWARK
Practice Address - State:DE
Practice Address - Zip Code:19713-3701
Practice Address - Country:US
Practice Address - Phone:302-575-1414
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-06-09
Last Update Date:2008-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DELG0000443363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily