Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 111NI0013X | Independent Medical Examiner | 14295 | TX |
NPI | 1124658976 |
---|---|
Provider Name | Dr. Kelsie Ann Miller |
First Address | Fort Worth, TX 76107-3000 |
Second Address | Fort Worth, TX 76107-3000 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/01/2020 |
Last Update Date | 21/01/2020 |