Provider Demographics
NPI:1932437118
Name:MILLER, KAY M (LPN, IBCLC)
Entity Type:Individual
Prefix:
First Name:KAY
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPN, IBCLC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3515 S PLEASANT ST
Mailing Address - Street 2:
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-3211
Mailing Address - Country:US
Mailing Address - Phone:816-210-5100
Mailing Address - Fax:
Practice Address - Street 1:3515 S PLEASANT ST
Practice Address - Street 2:
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-3211
Practice Address - Country:US
Practice Address - Phone:816-210-5100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-25
Last Update Date:2020-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004019329164W00000X
174H00000X, 374J00000X
L-96898174N00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes174N00000XOther Service ProvidersLactation Consultant, Non-RN
No164W00000XNursing Service ProvidersLicensed Practical Nurse
No174H00000XOther Service ProvidersHealth Educator
No374J00000XNursing Service Related ProvidersDoula