Provider Demographics
NPI:1972750065
Name:MILLER, KELLIE A (NNP-BC)
Entity type:Individual
Prefix:
First Name:KELLIE
Middle Name:A
Last Name:MILLER
Suffix:
Gender:F
Credentials:NNP-BC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:3740 W SYLVANIA AVE
Mailing Address - Street 2:SUITE 250
Mailing Address - City:TOLEDO
Mailing Address - State:OH
Mailing Address - Zip Code:43623-4461
Mailing Address - Country:US
Mailing Address - Phone:419-473-6670
Mailing Address - Fax:419-473-9959
Practice Address - Street 1:3740 W SYLVANIA AVE
Practice Address - Street 2:SUITE 250
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-4461
Practice Address - Country:US
Practice Address - Phone:419-473-6670
Practice Address - Fax:419-473-9959
Is Sole Proprietor?:No
Enumeration Date:2008-08-20
Last Update Date:2022-07-29
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MI4704235374363LN0000X
OHCOA10147NP363LP0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPediatrics
No363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal