MEDICARE: KYLAH JEAN ROSE 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	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	104100000X	Social Worker	SWB-2025-0098	NM

General Provider Information

NPI Number	:	1881358471
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KYLAH JEAN ROSE MILLER

Provider Business Mailing Address
First Line	:	3128 EXECUTIVE HILLS RD
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4724
Country	:	US
Telephone Number	:	575-993-3504
Fax Number	:

Provider Business Practice Location Address
First Line	:	2941 LOS AMIGOS CT
Second Line	:
City	:	LAS CRUCES
State	:	NM
Zip	:	88011-4836
Country	:	US
Telephone Number	:	575-993-3504
Fax Number	:

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

Provider Enumeration Date	:	10/28/2021
Last Update Date	:	03/05/2025

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