Provider Demographics
NPI:1881336030
Name:MILLER, KILEY AMANDA (ARNP)
Entity type:Individual
Prefix:
First Name:KILEY
Middle Name:AMANDA
Last Name:MILLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4772 W KONA DR
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814-4479
Mailing Address - Country:US
Mailing Address - Phone:509-863-6794
Mailing Address - Fax:
Practice Address - Street 1:546 N JEFFERSON LN
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-7104
Practice Address - Country:US
Practice Address - Phone:509-624-0111
Practice Address - Fax:509-227-7070
Is Sole Proprietor?:No
Enumeration Date:2022-04-08
Last Update Date:2022-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA61283004363LP2300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary Care