Healthcare Provider Details

I. General information

NPI: 1962074898
Provider Name (Legal Business Name): MATTHEW J MILLER NP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/12/2021
Last Update Date: 01/08/2024
Certification Date: 01/08/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 CLINT HILL BLVD
PADUCAH KY
42001-6768
US

IV. Provider business mailing address

200 CLINT HILL BLVD
PADUCAH KY
42001-6768
US

V. Phone/Fax

Practice location:
  • Phone: 270-442-9461
  • Fax: 270-441-0079
Mailing address:
  • Phone: 270-442-9461
  • Fax: 270-441-0079

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number3018712
License Number StateKY
# 2
Primary TaxonomyN
Taxonomy Code364SA2100X
TaxonomyAcute Care Clinical Nurse Specialist
License Number209023573
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: