Healthcare Provider Details

I. General information

NPI: 1053968495
Provider Name (Legal Business Name): ANNA KATHERINE JOHNSON MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2019
Last Update Date: 05/18/2026
Certification Date: 05/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

402 LANE ST
MONROE NC
28112-5456
US

IV. Provider business mailing address

402 LANE ST
MONROE NC
28112-5456
US

V. Phone/Fax

Practice location:
  • Phone: 704-233-3434
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number18263
License Number StateOR
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number2202009745
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number30004870
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: