Healthcare Provider Details

I. General information

NPI: 1134677230
Provider Name (Legal Business Name): KIMBERLY D MILLER AGCNS-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/17/2016
Last Update Date: 07/20/2021
Certification Date: 07/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1215 LEE ST OFC G014
CHARLOTTESVILLE VA
22908-0001
US

IV. Provider business mailing address

1215 LEE STREET INPATIENT DIABETES PROGRAM
CHARLOTTESVILLE VA
22908-0001
US

V. Phone/Fax

Practice location:
  • Phone: 434-327-3858
  • Fax:
Mailing address:
  • Phone: 434-243-9767
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number0001282907
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number0015001069
License Number StateVA
# 3
Primary TaxonomyY
Taxonomy Code364S00000X
TaxonomyClinical Nurse Specialist
License Number0024181937
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: