Provider Demographics
NPI:1215613245
Name:MILLER, KADY-ANN
Entity type:Individual
Prefix:
First Name:KADY-ANN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:45 PETRONELLI WAY APT 519
Mailing Address - Street 2:
Mailing Address - City:BROCKTON
Mailing Address - State:MA
Mailing Address - Zip Code:02301-4465
Mailing Address - Country:US
Mailing Address - Phone:857-334-5760
Mailing Address - Fax:
Practice Address - Street 1:45 PETRONELLI WAY
Practice Address - Street 2:
Practice Address - City:BROCKTON
Practice Address - State:MA
Practice Address - Zip Code:02301-4075
Practice Address - Country:US
Practice Address - Phone:857-334-5760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-06-26
Last Update Date:2023-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MARN2327697163W00000X, 163WC0200X, 163WI0500X, 163WH0200X, 163WM0705X, 163WP0000X, 163WP0808X, 208D00000X, 163WG0000X
MARN23276697163WA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
No163W00000XNursing Service ProvidersRegistered Nurse
No163WA0400XNursing Service ProvidersRegistered NurseAddiction (Substance Use Disorder)
No163WC0200XNursing Service ProvidersRegistered NurseCritical Care Medicine
No163WI0500XNursing Service ProvidersRegistered NurseInfusion Therapy
No163WH0200XNursing Service ProvidersRegistered NurseHome Health
No163WM0705XNursing Service ProvidersRegistered NurseMedical-Surgical
No163WP0000XNursing Service ProvidersRegistered NursePain Management
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No208D00000XAllopathic & Osteopathic PhysiciansGeneral Practice