Healthcare Provider Details

I. General information

NPI: 1356904262
Provider Name (Legal Business Name): KAYLA NICOLE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 04/16/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5121 STOCKDALE HWY STE 275
BAKERSFIELD CA
93309-2667
US

IV. Provider business mailing address

9902 SHERBORNE AVE APT C
BAKERSFIELD CA
93311-9082
US

V. Phone/Fax

Practice location:
  • Phone: 661-868-5000
  • Fax:
Mailing address:
  • Phone: 661-302-7719
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: