Provider Demographics
NPI:1174959951
Name:MILLER, KATHRYN NICHOLE (LM, CPM, RN)
Entity type:Individual
Prefix:
First Name:KATHRYN
Middle Name:NICHOLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:LM, CPM, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30415 BIRDHOUSE DR
Mailing Address - Street 2:
Mailing Address - City:WESLEY CHAPEL
Mailing Address - State:FL
Mailing Address - Zip Code:33545-1301
Mailing Address - Country:US
Mailing Address - Phone:813-506-1823
Mailing Address - Fax:
Practice Address - Street 1:30415 BIRDHOUSE DR
Practice Address - Street 2:
Practice Address - City:WESLEY CHAPEL
Practice Address - State:FL
Practice Address - Zip Code:33545-1301
Practice Address - Country:US
Practice Address - Phone:813-506-1823
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-24
Last Update Date:2014-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMW278176B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes176B00000XOther Service ProvidersMidwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL009778500Medicaid