Healthcare Provider Details

I. General information

NPI: 1336001270
Provider Name (Legal Business Name): ANGELA L MILLER LPN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/01/2025
Last Update Date: 12/01/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1974 WALTON NICHOLSON PIKE
INDEPENDENCE KY
41051-7906
US

IV. Provider business mailing address

1928 BRIDLE PATH
INDEPENDENCE KY
41051-8142
US

V. Phone/Fax

Practice location:
  • Phone: 877-654-6396
  • Fax:
Mailing address:
  • Phone: 859-640-4882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License Number2031529
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: