Provider Demographics
NPI:1841546975
Name:MILLER, KATHLEEN MICHELLE (NP)
Entity type:Individual
Prefix:MRS
First Name:KATHLEEN
Middle Name:MICHELLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:5265 NATORP BLVD
Mailing Address - Street 2:APT 318-B
Mailing Address - City:MASON
Mailing Address - State:OH
Mailing Address - Zip Code:45040
Mailing Address - Country:US
Mailing Address - Phone:740-502-7495
Mailing Address - Fax:
Practice Address - Street 1:610 WEST MAIN STREET
Practice Address - Street 2:EMERGENCY DEPARTMENT
Practice Address - City:WILMINGTON
Practice Address - State:OH
Practice Address - Zip Code:45177
Practice Address - Country:US
Practice Address - Phone:937-382-6611
Practice Address - Fax:513-466-8029
Is Sole Proprietor?:No
Enumeration Date:2012-07-26
Last Update Date:2024-08-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHCOA.13570-NP363LF0000X
OHAPRN.CNP.13570363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH1841546975Medicaid