=====================================================
General NPI Number Information
=====================================================
NPI Number | 1295721397
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | DEBRA D MILLER-FIKE CFNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/23/2005
-----------------------------------------------------
Last Update Date | 11/11/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 110 N PRICE ST
-----------------------------------------------------
City | KINGWOOD
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26537-1120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-329-3500
-----------------------------------------------------
Fax | 304-329-2088
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 110 N PRICE ST
-----------------------------------------------------
City | KINGWOOD
-----------------------------------------------------
State | WV
-----------------------------------------------------
Zip | 26537-1120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 304-329-3500
-----------------------------------------------------
Fax | 304-329-2088
-----------------------------------------------------
=====================================================
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 | 41176
-----------------------------------------------------
License Number State | WV
-----------------------------------------------------