MEDICARE: SALLY KATHLEEN MILLER APN

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	APN000709	NV
2	363LP0808X	Psychiatric/Mental Health Nurse Practitioner	APRN000709	NV

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	:	1801985296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY KATHLEEN MILLER APN

Provider Business Mailing Address
First Line	:	7416 WITTIG AVE
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89131-3213
Country	:	US
Telephone Number	:	702-612-8428
Fax Number	:	702-605-3085

Provider Business Practice Location Address
First Line	:	1607 E WINDMILL LN STE 300
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89123-1910
Country	:	US
Telephone Number	:	702-757-8720
Fax Number	:	702-605-3085

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

Provider Enumeration Date	:	10/12/2006
Last Update Date	:	12/20/2023

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