Healthcare Provider Details

I. General information

NPI: 1336432103
Provider Name (Legal Business Name): KIMBERLY JANE MILLER D.O.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/26/2011
Last Update Date: 11/26/2021
Certification Date: 11/11/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

294 PIPER ST
RICHLAND WA
99352-8703
US

IV. Provider business mailing address

6855 W CLEARWATER AVE STE A101-142
KENNEWICK WA
99336-5011
US

V. Phone/Fax

Practice location:
  • Phone: 509-980-1591
  • Fax: 509-350-4888
Mailing address:
  • Phone: 509-980-1591
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberOT014300
License Number StatePA
# 2
Primary TaxonomyY
Taxonomy Code207QG0300X
TaxonomyGeriatric Medicine (Family Medicine) Physician
License NumberOP60546764
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: