Basic Information
| Provider Information | |||||||||
| NPI: | 1841546975 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | KATHLEEN | ||||||||
| MiddleName: | MICHELLE | ||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5265 NATORP BLVD | ||||||||
| Address2: | APT 318-B | ||||||||
| City: | MASON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45040 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7405027495 | ||||||||
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| Practice Location | |||||||||
| Address1: | 610 WEST MAIN STREET | ||||||||
| Address2: | EMERGENCY DEPARTMENT | ||||||||
| City: | WILMINGTON | ||||||||
| State: | OH | ||||||||
| PostalCode: | 45177 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9373826611 | ||||||||
| FaxNumber: | 5134668029 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 07/26/2012 | ||||||||
| LastUpdateDate: | 11/09/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | COA.13570-NP | OH | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family |
No ID Information.