Provider Demographics
NPI:1528296274
Name:MILLER, LADONNA ANN (CST/CSFA, KCSA)
Entity type:Individual
Prefix:MS
First Name:LADONNA
Middle Name:ANN
Last Name:MILLER
Suffix:
Gender:F
Credentials:CST/CSFA, KCSA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2707 MADISON ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-3733
Mailing Address - Country:US
Mailing Address - Phone:270-217-3276
Mailing Address - Fax:
Practice Address - Street 1:2601 KENTUCKY AVE
Practice Address - Street 2:DOCTOR'S BUILDING 1, SUITE 103
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-3817
Practice Address - Country:US
Practice Address - Phone:270-444-9199
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2012-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY106545246ZS0410X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes246ZS0410XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherSurgical Technologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
KYSA227OtherKENTUCKY BOARD OF MEDICAL LICENSURE