Provider Demographics
NPI:1326850298
Name:MILLER, BETHANY (RDN)
Entity type:Individual
Prefix:
First Name:BETHANY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:RDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:601 E PICCADILLY DR APT 411
Mailing Address - Street 2:
Mailing Address - City:FLAGSTAFF
Mailing Address - State:AZ
Mailing Address - Zip Code:86001-5978
Mailing Address - Country:US
Mailing Address - Phone:858-922-1108
Mailing Address - Fax:
Practice Address - Street 1:601 E PICCADILLY DR APT 411
Practice Address - Street 2:
Practice Address - City:FLAGSTAFF
Practice Address - State:AZ
Practice Address - Zip Code:86001-5978
Practice Address - Country:US
Practice Address - Phone:858-922-1108
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-01-27
Last Update Date:2025-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ86359283133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered