Provider Demographics
NPI:1982053674
Name:MILLER, KERRY ELIZABETH (LCSW, APRN, PMHNP-BC)
Entity type:Individual
Prefix:MS
First Name:KERRY
Middle Name:ELIZABETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:LCSW, APRN, PMHNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1801 W KOENIG LN
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78756-1208
Mailing Address - Country:US
Mailing Address - Phone:512-553-5382
Mailing Address - Fax:
Practice Address - Street 1:1801 W KOENIG LN
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78756-1208
Practice Address - Country:US
Practice Address - Phone:512-553-5382
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-06-03
Last Update Date:2019-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX578661041C0700X
TX926242163W00000X
TXAP142355363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No163W00000XNursing Service ProvidersRegistered Nurse