Healthcare Provider Details

I. General information

NPI: 1184189268
Provider Name (Legal Business Name): KATHERINE MILLER CPM
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: KATY MILLER CPM

II. Dates (important events)

Enumeration Date: 02/04/2019
Last Update Date: 02/04/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7620 S EAGLE RD
COLUMBIA MO
65203-9036
US

IV. Provider business mailing address

7620 S EAGLE RD
COLUMBIA MO
65203-9036
US

V. Phone/Fax

Practice location:
  • Phone: 573-449-6161
  • Fax:
Mailing address:
  • Phone: 573-449-6161
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code176B00000X
TaxonomyMidwife
License Number19010012
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: