Healthcare Provider Details

I. General information

NPI: 1619821972
Provider Name (Legal Business Name): BRANDON MILLER APRN
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/24/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 BLACK GOLD BLVD
HAZARD KY
41701-2620
US

IV. Provider business mailing address

210 BLACK GOLD BLVD
HAZARD KY
41701-2620
US

V. Phone/Fax

Practice location:
  • Phone: 606-487-7000
  • Fax: 606-487-7022
Mailing address:
  • Phone: 606-487-7000
  • Fax: 606-487-7022

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number4054448
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: