Provider Demographics
NPI:1063985984
Name:MILLER, ANGEL (APRN)
Entity type:Individual
Prefix:
First Name:ANGEL
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21890
Mailing Address - Street 2:
Mailing Address - City:BELFAST
Mailing Address - State:ME
Mailing Address - Zip Code:04915-4115
Mailing Address - Country:US
Mailing Address - Phone:502-907-0356
Mailing Address - Fax:502-919-9780
Practice Address - Street 1:1107 CROWN POINTE DR STE 107
Practice Address - Street 2:
Practice Address - City:ELIZABETHTOWN
Practice Address - State:KY
Practice Address - Zip Code:42701-7280
Practice Address - Country:US
Practice Address - Phone:270-506-3300
Practice Address - Fax:270-506-2843
Is Sole Proprietor?:No
Enumeration Date:2019-01-03
Last Update Date:2022-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3012440363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
14388051OtherCAQH PROVIDER ID
KYPDZ000000228298OtherAETNA BETTER HEALTH OF KY PROVIDER ID NUMBER
6976343OtherUNITED HEALTHCARE PROVIDER ID NUMBER
CS1908400320OtherCARESOURCE PROVIDER ID NUMBER
KY7100579240Medicaid
IN300021545Medicaid
6645104OtherAETNA PROVIDER ID NUMBER
000001232675OtherANTHEM PROVIDER ID NUMBER
KY1796137OtherWELLCARE OF KY PROVIDER ID NUMBER