Provider Demographics
NPI:1699528877
Name:MILLER, COREY JAMES (APRN)
Entity type:Individual
Prefix:MR
First Name:COREY
Middle Name:JAMES
Last Name:MILLER
Suffix:
Gender:M
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:604 N 36TH ST
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-4719
Mailing Address - Country:US
Mailing Address - Phone:270-217-1930
Mailing Address - Fax:
Practice Address - Street 1:2725 JAMES SANDERS BLVD
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-8405
Practice Address - Country:US
Practice Address - Phone:270-554-5114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-04-08
Last Update Date:2024-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY4009033363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily