Healthcare Provider Details

I. General information

NPI: 1366044323
Provider Name (Legal Business Name): KELSEY ELIZABETH MILLER APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/13/2020
Last Update Date: 11/13/2020
Certification Date: 11/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 MEDICAL PARK STE 300
WHEELING WV
26003-6389
US

IV. Provider business mailing address

969 COOPER LN
PROCTOR WV
26055-1424
US

V. Phone/Fax

Practice location:
  • Phone: 304-242-3900
  • Fax: 304-242-8564
Mailing address:
  • Phone: 304-771-8264
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number107141
License Number StateWV

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: