=====================================================
General NPI Number Information
=====================================================
NPI Number | 1063640571
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JOHN C MILLER NP
-----------------------------------------------------
Gender | Male
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/24/2009
-----------------------------------------------------
Last Update Date | 06/24/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1 SAINT JOSEPH DR SAINT JOSEPH HOSPITAL
-----------------------------------------------------
City | LEXINGTON
-----------------------------------------------------
State | KY
-----------------------------------------------------
Zip | 40504-3742
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 859-313-1176
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1431 CENTERPOINT BLVD SUITE 100
-----------------------------------------------------
City | KNOXVILLE
-----------------------------------------------------
State | TN
-----------------------------------------------------
Zip | 37932-1984
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 865-985-7068
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363L00000X
-----------------------------------------------------
Taxonomy Name | Nurse Practitioner
-----------------------------------------------------
License Number | PENDING
-----------------------------------------------------
License Number State | KY
-----------------------------------------------------