MEDICARE: CRISTAL MILLER PA-C

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	363AM0700X	Medical Physician Assistant	PA922	KY
2	363AS0400X	Surgical Physician Assistant	PA922	KY
3	363A00000X	Physician Assistant	PA922	KY

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	:	1790727998
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CRISTAL MILLER PA-C

Provider Business Mailing Address
First Line	:	615 ELSINORE PL STE 200
Second Line	:
City	:	CINCINNATI
State	:	OH
Zip	:	45202-1457
Country	:	US
Telephone Number	:	513-834-7063
Fax Number	:

Provider Business Practice Location Address
First Line	:	2400 GREATSTONE PT
Second Line	:
City	:	LEXINGTON
State	:	KY
Zip	:	40504-3274
Country	:	US
Telephone Number	:	859-218-5999
Fax Number	:	859-257-0670

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

Provider Enumeration Date	:	06/12/2006
Last Update Date	:	11/17/2022

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Directions to “ CRISTAL MILLER PA-C” Practice Location

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