Healthcare Provider Details

I. General information

NPI: 1275317240
Provider Name (Legal Business Name): DAVID H MILLER PMHNP-BC
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/22/2023
Last Update Date: 10/09/2024
Certification Date: 10/09/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 RAINBOW BLVD
EXCELSIOR SPRINGS MO
64024-1182
US

IV. Provider business mailing address

1700 RAINBOW BLVD
EXCELSIOR SPRINGS MO
64024-1182
US

V. Phone/Fax

Practice location:
  • Phone: 816-629-6596
  • Fax: 816-629-2701
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2023031945
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: