Healthcare Provider Details

I. General information

NPI: 1699451013
Provider Name (Legal Business Name): KAYLA MILLER RN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/22/2023
Last Update Date: 06/22/2023
Certification Date: 06/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1308 ELBOWOOD LN
BISMARCK ND
58503-5712
US

IV. Provider business mailing address

525 N 9TH ST
BISMARCK ND
58501-4510
US

V. Phone/Fax

Practice location:
  • Phone: 701-751-8260
  • Fax:
Mailing address:
  • Phone: 701-751-2887
  • Fax: 701-751-0887

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WA0400X
TaxonomyAddiction (Substance Use Disorder) Registered Nurse
License NumberR40879
License Number StateND
# 2
Primary TaxonomyN
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License NumberR40879
License Number StateND
# 3
Primary TaxonomyY
Taxonomy Code163WA2000X
TaxonomyAdministrator Registered Nurse
License NumberR40879
License Number StateND
# 4
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberR40879
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: