Healthcare Provider Details

I. General information

NPI: 1881358471
Provider Name (Legal Business Name): KYLAH JEAN ROSE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/28/2021
Last Update Date: 08/07/2026
Certification Date: 08/07/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

414 N MAIN ST
LAS CRUCES NM
88001-1281
US

IV. Provider business mailing address

5305 PISTOLERO PL
LAS CRUCES NM
88012-8086
US

V. Phone/Fax

Practice location:
  • Phone: 575-993-3504
  • Fax:
Mailing address:
  • Phone: 575-993-3504
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License NumberSWB-2026-1051
License Number StateNM
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License NumberSWB-2025-0098
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: