Provider Demographics
NPI:1588431621
Name:MILLER, KASIE VICTORIA (LPN)
Entity type:Individual
Prefix:
First Name:KASIE
Middle Name:VICTORIA
Last Name:MILLER
Suffix:
Gender:F
Credentials:LPN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PROSPERITY DR # 209
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4718
Mailing Address - Country:US
Mailing Address - Phone:865-399-7039
Mailing Address - Fax:
Practice Address - Street 1:200 PROSPERITY DR # 209
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4718
Practice Address - Country:US
Practice Address - Phone:865-399-7039
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-12-08
Last Update Date:2023-12-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34517251E00000X
TN3511251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health