MEDICARE: KANISHA R MILLER NP

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	10748-33	WI
2	363LF0000X	Family Nurse Practitioner	10748-33	WI
3	363LF0000X	Family Nurse Practitioner	238005	LA

General Provider Information

NPI Number	:	1699341834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KANISHA R MILLER NP

Provider Business Mailing Address
First Line	:	5959 S SHERWOOD FOREST BLVD
Second Line	:
City	:	BATON ROUGE
State	:	LA
Zip	:	70816-6038
Country	:	US
Telephone Number	:	225-644-0005
Fax Number	:	225-765-9196

Provider Business Practice Location Address
First Line	:	10714 HIGHWAY 431
Second Line	:
City	:	SAINT AMANT
State	:	LA
Zip	:	70774-3904
Country	:	US
Telephone Number	:	225-644-0005
Fax Number	:	225-644-0085

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

Provider Enumeration Date	:	05/28/2021
Last Update Date	:	11/17/2025

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Directions to “ KANISHA R MILLER NP” Practice Location

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