Provider Demographics
NPI:1699726596
Name:MILLER, GINNY (APRN)
Entity type:Individual
Prefix:MRS
First Name:GINNY
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 MEDICAL CENTER DR STE 203
Mailing Address - Street 2:
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42003-7907
Mailing Address - Country:US
Mailing Address - Phone:270-415-6100
Mailing Address - Fax:
Practice Address - Street 1:225 MEDICAL CENTER DR STE 203
Practice Address - Street 2:
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42003-7907
Practice Address - Country:US
Practice Address - Phone:270-415-6100
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-15
Last Update Date:2023-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004789363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY78017142Medicaid
KYP400039369Medicare PIN
KY78017142Medicaid
KYQ69783Medicare UPIN
KY0910608OtherUMWA
753596OtherHEALTH LINK
KY78017142Medicaid