Provider Demographics
NPI:1710713318
Name:KEYVION MILLER NUTRITION, LLC
Entity type:Organization
Organization Name:KEYVION MILLER NUTRITION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:KEYVION
Authorized Official - Middle Name:DONNISHA
Authorized Official - Last Name:MILLER
Authorized Official - Suffix:
Authorized Official - Credentials:RD
Authorized Official - Phone:321-948-8089
Mailing Address - Street 1:6213 CENTENNIAL DR
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32808-1821
Mailing Address - Country:US
Mailing Address - Phone:321-948-8089
Mailing Address - Fax:
Practice Address - Street 1:6213 CENTENNIAL DR
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32808-1821
Practice Address - Country:US
Practice Address - Phone:321-948-8089
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, RegisteredGroup - Single Specialty