Healthcare Provider Details

I. General information

NPI: 1063640571
Provider Name (Legal Business Name): JOHN C MILLER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/24/2009
Last Update Date: 06/24/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 SAINT JOSEPH DR SAINT JOSEPH HOSPITAL
LEXINGTON KY
40504-3742
US

IV. Provider business mailing address

1431 CENTERPOINT BLVD SUITE 100
KNOXVILLE TN
37932-1984
US

V. Phone/Fax

Practice location:
  • Phone: 859-313-1176
  • Fax:
Mailing address:
  • Phone: 865-985-7068
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License NumberPENDING
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: