Provider Demographics
NPI:1134560691
Name:MILLER, SUSAN KAY (PMHNP)
Entity type:Individual
Prefix:
First Name:SUSAN
Middle Name:KAY
Last Name:MILLER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:SUSAN
Other - Middle Name:KAY
Other - Last Name:MCCULLAH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1431 SANTA CRUZ
Mailing Address - Street 2:
Mailing Address - City:LONGVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:75601-8629
Mailing Address - Country:US
Mailing Address - Phone:360-918-1154
Mailing Address - Fax:
Practice Address - Street 1:5201 GREAT AMERICA PKWY STE 320
Practice Address - Street 2:
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95054-1140
Practice Address - Country:US
Practice Address - Phone:323-205-7088
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-07-12
Last Update Date:2025-07-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA23120363LF0000X, 363LP0808X
OR201500014NP-PP363LF0000X
WAAP60508964363LF0000X
WAN360543041363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health