MEDICARE: KELLI A MILLER APRN

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	201950	NC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	133E0	OTHER	NC	BCBS
2	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1780660118
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLI A MILLER APRN

Provider Business Mailing Address
First Line	:	4129 MOUNTAIN COVE DR
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28216-7776
Country	:	US
Telephone Number	:	704-393-3593
Fax Number	:

Provider Business Practice Location Address
First Line	:	294 N HIGHWAY 16
Second Line	:	SUITE A
City	:	DENVER
State	:	NC
Zip	:	28037-8011
Country	:	US
Telephone Number	:	704-489-2400
Fax Number	:	704-489-2900

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

Provider Enumeration Date	:	12/18/2005
Last Update Date	:	06/17/2008

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Directions to “ KELLI A MILLER APRN” Practice Location

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