MEDICARE: JAMESETTA KAIDDY MILLER

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	3747P1801X	Personal Care Attendant	100678	MA
2	3747P1801X	Personal Care Attendant	100678	ND

General Provider Information

NPI Number	:	1740996065
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JAMESETTA KAIDDY MILLER

Provider Business Mailing Address
First Line	:	1104 JEFFERSON PL
Second Line	:
City	:	BELLINGHAM
State	:	MA
Zip	:	02019-1368
Country	:	US
Telephone Number	:	702-960-8706
Fax Number	:

Provider Business Practice Location Address
First Line	:	1104 JEFFERSON PL
Second Line	:
City	:	BELLINGHAM
State	:	MA
Zip	:	02019-1368
Country	:	US
Telephone Number	:	702-960-8706
Fax Number	:

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

Provider Enumeration Date	:	01/30/2023
Last Update Date	:	12/12/2024

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Directions to “ JAMESETTA KAIDDY MILLER ” Practice Location

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