Healthcare Provider Details

I. General information

NPI: 1558957522
Provider Name (Legal Business Name): KATHERINE LYNN MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/14/2020
Last Update Date: 12/14/2020
Certification Date: 12/14/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6258 ALLENS FORK RD
CHARLESTON WV
25320-7096
US

IV. Provider business mailing address

6258 ALLENS FORK RD
CHARLESTON WV
25320-7096
US

V. Phone/Fax

Practice location:
  • Phone: 304-988-0609
  • Fax:
Mailing address:
  • Phone: 304-988-0609
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number64580
License Number StateWV
# 2
Primary TaxonomyY
Taxonomy Code163WW0101X
TaxonomyAmbulatory Women's Health Care Registered Nurse
License Number64590
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: