Provider Demographics
NPI:1144828518
Name:MILLER, KIMBERLY LOWERY (LPA)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:LOWERY
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2572 PRIMROSE LN
Mailing Address - Street 2:
Mailing Address - City:CREEDMOOR
Mailing Address - State:NC
Mailing Address - Zip Code:27522-7819
Mailing Address - Country:US
Mailing Address - Phone:919-538-6333
Mailing Address - Fax:
Practice Address - Street 1:205 GARDEN HEIGHTS LN
Practice Address - Street 2:
Practice Address - City:HILLSBOROUGH
Practice Address - State:NC
Practice Address - Zip Code:27278-9937
Practice Address - Country:US
Practice Address - Phone:919-818-3207
Practice Address - Fax:919-245-8885
Is Sole Proprietor?:No
Enumeration Date:2020-10-16
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC2065103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities