Healthcare Provider Details

I. General information

NPI: 1346559895
Provider Name (Legal Business Name): KELLY D MILLER APN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/01/2010
Last Update Date: 11/15/2024
Certification Date: 11/15/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9527 W RIDGE TRAIL RD
SODDY DAISY TN
37379-4018
US

IV. Provider business mailing address

921 E 3RD ST
CHATTANOOGA TN
37403-2102
US

V. Phone/Fax

Practice location:
  • Phone: 423-209-5490
  • Fax: 423-498-4584
Mailing address:
  • Phone: 423-209-8000
  • Fax: 423-209-8001

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LX0001X
TaxonomyObstetrics & Gynecology Nurse Practitioner
License NumberAPN0000015146
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: