Healthcare Provider Details

I. General information

NPI: 1164736971
Provider Name (Legal Business Name): KIMBERLY LYNN MILLER CNS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/04/2010
Last Update Date: 09/09/2020
Certification Date: 09/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4351 E LOHMAN AVE STE 201
LAS CRUCES NM
88011-8260
US

IV. Provider business mailing address

4351 E LOHMAN AVE STE 201
LAS CRUCES NM
88011-8260
US

V. Phone/Fax

Practice location:
  • Phone: 575-522-2233
  • Fax: 575-522-2266
Mailing address:
  • Phone: 575-522-2233
  • Fax: 575-522-2266

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code364SA2200X
TaxonomyAdult Health Clinical Nurse Specialist
License NumberCNS-00222
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: