Healthcare Provider Details

I. General information

NPI: 1659787273
Provider Name (Legal Business Name): KINDRA MIILLER NP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/02/2014
Last Update Date: 11/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1055 N CURTIS ROAD
BOISE ID
83706
US

IV. Provider business mailing address

3340 E GOLDSTONE WAY
MERIDIAN ID
83642-1026
US

V. Phone/Fax

Practice location:
  • Phone: 208-367-7950
  • Fax: 208-367-3951
Mailing address:
  • Phone: 208-367-7950
  • Fax: 208-367-3951

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberNP-1445A
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP60495434
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: