Provider Demographics
NPI:1750895256
Name:MILLER, KILEY SHAW
Entity type:Individual
Prefix:MS
First Name:KILEY
Middle Name:SHAW
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KILEY
Other - Middle Name:RENEA
Other - Last Name:CRANER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:9615 ROBERTS DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:OH
Mailing Address - Zip Code:45005-1029
Mailing Address - Country:US
Mailing Address - Phone:513-571-2988
Mailing Address - Fax:
Practice Address - Street 1:9615 ROBERTS DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:OH
Practice Address - Zip Code:45005-1029
Practice Address - Country:US
Practice Address - Phone:513-571-2988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-11-21
Last Update Date:2017-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHTS404666374U00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide