Healthcare Provider Details

I. General information

NPI: 1336004464
Provider Name (Legal Business Name): KACEY L. MILLER REGISTERED NURSE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/20/2025
Last Update Date: 12/20/2025
Certification Date: 12/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

212 NW 5TH STREET
GUYMON OK
73942-4204
US

IV. Provider business mailing address

212 NW 5TH STREET
GUYMON OK
73942-4204
US

V. Phone/Fax

Practice location:
  • Phone: 580-338-7462
  • Fax: 855-538-3350
Mailing address:
  • Phone: 580-338-7462
  • Fax: 855-538-3350

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WP0808X
TaxonomyPsychiatric/Mental Health Registered Nurse
License Number218462
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: