Healthcare Provider Details

I. General information

NPI: 1427692797
Provider Name (Legal Business Name): JAMES ALBERT MILLER
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/30/2019
Last Update Date: 11/03/2021
Certification Date: 11/03/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 MEDICAL VILLAGE DR
EDGEWOOD KY
41017
US

IV. Provider business mailing address

PO BOX 636324
CINCINNATI OH
45263-6324
US

V. Phone/Fax

Practice location:
  • Phone: 859-301-0124
  • Fax: 859-301-0699
Mailing address:
  • Phone: 859-301-0124
  • Fax: 859-301-0699

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number3015749
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAPRN.CNP.025783
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: