MEDICARE: KYLEE RAE MILLER CRNP

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	363LA2100X	Acute Care Nurse Practitioner	1-145596	AL

General Provider Information

NPI Number	:	1821702705
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLEE RAE MILLER CRNP

Provider Business Mailing Address
First Line	:	1116 BAGLEY DR
Second Line	:
City	:	FAYETTEVILLE
State	:	TN
Zip	:	37334-2138
Country	:	US
Telephone Number	:	256-656-3155
Fax Number	:

Provider Business Practice Location Address
First Line	:	13596 HIGHWAY 231 431 N STE 4
Second Line	:
City	:	HAZEL GREEN
State	:	AL
Zip	:	35750-8618
Country	:	US
Telephone Number	:	256-428-4990
Fax Number	:	256-428-4991

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

Provider Enumeration Date	:	01/06/2023
Last Update Date	:	10/28/2025

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