Provider Demographics
NPI:1720070089
Name:MILLER, WILLIAM MORGAN (PA)
Entity Type:Individual
Prefix:MR
First Name:WILLIAM
Middle Name:MORGAN
Last Name:MILLER
Suffix:
Gender:M
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:PO BOX 39
Mailing Address - Street 2:
Mailing Address - City:EVARTS
Mailing Address - State:KY
Mailing Address - Zip Code:40828-0039
Mailing Address - Country:US
Mailing Address - Phone:606-837-2108
Mailing Address - Fax:606-837-2111
Practice Address - Street 1:101 CHAD ST
Practice Address - Street 2:
Practice Address - City:EVARTS
Practice Address - State:KY
Practice Address - Zip Code:40828-0039
Practice Address - Country:US
Practice Address - Phone:606-837-2108
Practice Address - Fax:606-837-2111
Is Sole Proprietor?:No
Enumeration Date:2005-08-22
Last Update Date:2010-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYPA388363AM0700X
KYPA-388363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY95002606Medicaid
KY95002606Medicaid
0264650Medicare ID - Type Unspecified