Provider Demographics
NPI:1912972175
Name:MILLER, KRISTOPHER JAMES (MSPA)
Entity Type:Individual
Prefix:
First Name:KRISTOPHER
Middle Name:JAMES
Last Name:MILLER
Suffix:
Gender:M
Credentials:MSPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3225 HOSPITAL DR UNIT 101A
Mailing Address - Street 2:
Mailing Address - City:JUNEAU
Mailing Address - State:AK
Mailing Address - Zip Code:99801-7863
Mailing Address - Country:US
Mailing Address - Phone:907-523-5411
Mailing Address - Fax:907-523-9884
Practice Address - Street 1:3225 HOSPITAL DR UNIT 101A
Practice Address - Street 2:
Practice Address - City:JUNEAU
Practice Address - State:AK
Practice Address - Zip Code:99801-7863
Practice Address - Country:US
Practice Address - Phone:907-523-5411
Practice Address - Fax:907-523-9884
Is Sole Proprietor?:No
Enumeration Date:2006-02-21
Last Update Date:2011-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORPA00769363AM0700X
AK944363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical