Healthcare Provider Details

I. General information

NPI: 1780918573
Provider Name (Legal Business Name): SUZETTE MILLER PMH-NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SUZETTE TRENT

II. Dates (important events)

Enumeration Date: 09/25/2009
Last Update Date: 01/22/2024
Certification Date: 01/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

102 MEDICAL CENTER DR
HAZARD KY
41701-9421
US

IV. Provider business mailing address

181 ROY CAMPBELL DR
HAZARD KY
41701-9407
US

V. Phone/Fax

Practice location:
  • Phone: 606-439-1331
  • Fax: 606-439-6701
Mailing address:
  • Phone: 606-439-1316
  • Fax: 606-439-8457

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number3006201
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: