Provider Demographics
NPI:1962454397
Name:MILLER, KIMBERLY L (MD)
Entity type:Individual
Prefix:
First Name:KIMBERLY
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:MD
Other - Prefix:
Other - First Name:KIMBERLY
Other - Middle Name:L
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MD
Mailing Address - Street 1:1256 W EXCHANGE PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:ALLEN
Mailing Address - State:TX
Mailing Address - Zip Code:75013-7049
Mailing Address - Country:US
Mailing Address - Phone:972-649-5480
Mailing Address - Fax:469-854-6664
Practice Address - Street 1:1256 W EXCHANGE PKWY STE 200
Practice Address - Street 2:
Practice Address - City:ALLEN
Practice Address - State:TX
Practice Address - Zip Code:75013-7049
Practice Address - Country:US
Practice Address - Phone:972-649-5480
Practice Address - Fax:972-649-6664
Is Sole Proprietor?:Yes
Enumeration Date:2006-05-16
Last Update Date:2024-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXM1354208000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208000000XAllopathic & Osteopathic PhysiciansPediatrics