Healthcare Provider Details

I. General information

NPI: 1376824219
Provider Name (Legal Business Name): KRISTIN MILLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/06/2011
Last Update Date: 05/04/2023
Certification Date: 05/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6119 ST HIGHWAY
CANTON NY
13617
US

IV. Provider business mailing address

275 ASHTON ROAD
POTSDAM NY
13676
US

V. Phone/Fax

Practice location:
  • Phone: 315-265-0394
  • Fax:
Mailing address:
  • Phone: 315-396-7266
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberRN2270587
License Number StateMA
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number337333
License Number StateNY
# 3
Primary TaxonomyN
Taxonomy Code207X00000X
TaxonomyOrthopaedic Surgery Physician
License Number337333
License Number StateNY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: