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General NPI Number Information
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NPI Number | 1124096953
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Entity Type | Individual
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Provider Name | KEVYN J MILLER PA
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Gender | Male
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Dates
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Enumeration Date | 03/09/2006
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Last Update Date | 05/18/2023
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Provider Practice Location Address
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Address Line | 421 N MAIN ST
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City | LEEDS
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State | MA
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Zip | 01053-9764
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Country | US
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Telephone | 413-584-4040
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 601943
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City | CHARLOTTE
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State | NC
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Zip | 28260-1943
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Country | US
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Telephone | 704-512-6850
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 0010-01620
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License Number State | NC
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number | 1680
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License Number State | MA
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Taxonomy #3
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1680
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License Number State | MA
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