Healthcare Provider Details

I. General information

NPI: 1447073093
Provider Name (Legal Business Name): KENDRA MILLER CPNP-PC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/04/2024
Last Update Date: 11/04/2024
Certification Date: 11/03/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

929 N MAIN ST
MARION VA
24354-4117
US

IV. Provider business mailing address

929 N MAIN ST
MARION VA
24354-4117
US

V. Phone/Fax

Practice location:
  • Phone: 276-783-8183
  • Fax: 276-782-9267
Mailing address:
  • Phone: 276-783-8183
  • Fax: 276-782-9267

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number0024191550
License Number StateVA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: