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General NPI Number Information
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NPI Number | 1114627783
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Entity Type | Individual
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Provider Name | KRISTINE MILLER PA-C
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Gender | Female
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Dates
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Enumeration Date | 03/03/2023
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Last Update Date | 02/24/2025
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Provider Practice Location Address
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Address Line | 9934 E WASHINGTON ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46229-3040
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Country | US
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Telephone | 866-434-3255
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Fax |
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Provider Business Mailing Address
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Address Line | 5338 BROADWAY ST
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City | INDIANAPOLIS
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State | IN
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Zip | 46220-3138
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Country | US
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Telephone | 810-614-2014
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 10003939A
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License Number State | IN
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Taxonomy #2
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number |
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License Number State |
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