Healthcare Provider Details

I. General information

NPI: 1215613245
Provider Name (Legal Business Name): KADY-ANN MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/26/2023
Last Update Date: 06/26/2023
Certification Date: 06/24/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

45 PETRONELLI WAY
BROCKTON MA
02301-4075
US

IV. Provider business mailing address

45 PETRONELLI WAY APT 519
BROCKTON MA
02301-4465
US

V. Phone/Fax

Practice location:
  • Phone: 857-334-5760
  • Fax:
Mailing address:
  • Phone: 857-334-5760
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163W00000X
TaxonomyRegistered Nurse
License NumberRN2327697
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberRN23276697
License Number StateMA
# 3
Primary TaxonomyN
Taxonomy Code163WC0200X
TaxonomyCritical Care Medicine Registered Nurse
License NumberRN2327697
License Number StateMA
# 4
Primary TaxonomyN
Taxonomy Code163WI0500X
TaxonomyInfusion Therapy Registered Nurse
License NumberRN2327697
License Number StateMA
# 5
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberRN2327697
License Number StateMA
# 6
Primary TaxonomyN
Taxonomy Code163WM0705X
TaxonomyMedical-Surgical Registered Nurse
License NumberRN2327697
License Number StateMA
# 7
Primary TaxonomyN
Taxonomy Code163WP0000X
TaxonomyPain Management Registered Nurse
License NumberRN2327697
License Number StateMA
# 8
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberRN2327697
License Number StateMA
# 9
Primary TaxonomyN
Taxonomy Code208D00000X
TaxonomyGeneral Practice Physician
License NumberRN2327697
License Number StateMA
# 10
Primary TaxonomyY
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License NumberRN2327697
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: