Provider Demographics
NPI:1972713675
Name:MILLER, KATHLEEN MARY (APRN, BC, PNP)
Entity type:Individual
Prefix:MS
First Name:KATHLEEN
Middle Name:MARY
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN, BC, PNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:154 WATERS EDGE
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:NY
Mailing Address - Zip Code:12549-1309
Mailing Address - Country:US
Mailing Address - Phone:845-457-4683
Mailing Address - Fax:
Practice Address - Street 1:53 GIBSON RD
Practice Address - Street 2:ORANGE ULSTER
Practice Address - City:GOSHEN
Practice Address - State:NY
Practice Address - Zip Code:10924-6709
Practice Address - Country:US
Practice Address - Phone:845-291-0275
Practice Address - Fax:845-291-0198
Is Sole Proprietor?:No
Enumeration Date:2007-05-23
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NYF380302-1363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics