Healthcare Provider Details

I. General information

NPI: 1497963391
Provider Name (Legal Business Name): KERRI DIANNE MILLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/21/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2759 PETROS BROWNING RD
ROCKFIELD KY
42274-9762
US

IV. Provider business mailing address

2759 PETROS BROWNING RD
ROCKFIELD KY
42274-9762
US

V. Phone/Fax

Practice location:
  • Phone: 270-535-2855
  • Fax: 270-846-2855
Mailing address:
  • Phone: 270-535-2855
  • Fax: 270-846-2855

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License Number1110646
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: