Provider Demographics
NPI:1730776071
Name:MILLER, KIMBERLY A
Entity type:Individual
Prefix:MRS
First Name:KIMBERLY
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:820B RIDDLEBARGER RD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:OH
Mailing Address - Zip Code:45662-8922
Mailing Address - Country:US
Mailing Address - Phone:740-820-5981
Mailing Address - Fax:
Practice Address - Street 1:820B RIDDLEBARGER RD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:OH
Practice Address - Zip Code:45662-8922
Practice Address - Country:US
Practice Address - Phone:740-820-5981
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-12-21
Last Update Date:2020-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH7301824376J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376J00000XNursing Service Related ProvidersHomemaker
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH2813263Medicaid