Provider Demographics
NPI:1194964759
Name:MILLER, KIMBERLY (LAC)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:LAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3653 IMAGE DR
Mailing Address - Street 2:
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99504-4374
Mailing Address - Country:US
Mailing Address - Phone:907-268-1617
Mailing Address - Fax:
Practice Address - Street 1:717 BARROW ST
Practice Address - Street 2:
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99501-3632
Practice Address - Country:US
Practice Address - Phone:907-268-1617
Practice Address - Fax:833-333-1499
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-05
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK188686171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA0240989OtherWASHINGTON DEPARTMENT OF LABOR & INDUSTRIES