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General NPI Number Information
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NPI Number | 1144779489
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Entity Type | Individual
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Provider Name | KELLY MARISA MILLER PA-C
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Gender | Female
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Dates
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Enumeration Date | 09/28/2016
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Last Update Date | 01/02/2024
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Provider Practice Location Address
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Address Line | 1101 NOTT ST
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City | SCHENECTADY
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State | NY
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Zip | 12308-2425
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Country | US
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Telephone | 518-243-4001
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Fax |
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Provider Business Mailing Address
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Address Line | 1101 NOTT STREET CATH LAB A2
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City | SCHENECTADY
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State | NY
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Zip | 12308
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Country | US
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Telephone | 518-243-4001
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Fax | 182-434-4335
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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 | 020187
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License Number State | NY
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