MEDICARE: KIM MILLER APN/CNP

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	363L00000X	Nurse Practitioner	209004811	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1285638262
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KIM MILLER APN/CNP

Provider Business Mailing Address
First Line	:	1200 N STATE HIGHWAY 121
Second Line	:
City	:	MT ZION
State	:	IL
Zip	:	62549-1224
Country	:	US
Telephone Number	:	217-864-5531
Fax Number	:	217-864-2449

Provider Business Practice Location Address
First Line	:	1200 N STATE HIGHWAY 121
Second Line	:
City	:	MT ZION
State	:	IL
Zip	:	62549-1224
Country	:	US
Telephone Number	:	217-864-5531
Fax Number	:	217-864-2449

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

Provider Enumeration Date	:	06/08/2005
Last Update Date	:	03/10/2011

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