MEDICARE: KIMBERLY MILLER FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	2013029768	MO

General Provider Information

NPI Number	:	1124447677
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIMBERLY MILLER FNP

Provider Business Mailing Address
First Line	:	508 BROWN ST
Second Line	:
City	:	UNION
State	:	MO
Zip	:	63084-1404
Country	:	US
Telephone Number	:	636-390-1627
Fax Number	:	636-390-1760

Provider Business Practice Location Address
First Line	:	11560 OLIVE BLVD
Second Line	:
City	:	CREVE COEUR
State	:	MO
Zip	:	63141-7111
Country	:	US
Telephone Number	:	314-995-7128
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/14/2014
Last Update Date	:	04/05/2023

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