Provider Demographics
NPI:1750978292
Name:MILLER, KAYLA
Entity type:Individual
Prefix:
First Name:KAYLA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:600 COPELAND AVE
Mailing Address - Street 2:
Mailing Address - City:MANVEL
Mailing Address - State:ND
Mailing Address - Zip Code:58256-4022
Mailing Address - Country:US
Mailing Address - Phone:701-213-8299
Mailing Address - Fax:
Practice Address - Street 1:600 COPELAND AVE
Practice Address - Street 2:
Practice Address - City:MANVEL
Practice Address - State:ND
Practice Address - Zip Code:58256-4022
Practice Address - Country:US
Practice Address - Phone:701-213-8299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-12-30
Last Update Date:2020-12-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
372500000X, 376J00000X
ND3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant
No372500000XNursing Service Related ProvidersChore Provider
No376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
ND1470464OtherQSP NUMBER