Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LP0200X | Nurse Practitioner - Pediatrics | APRN.CNP.019572 | OH |
N | 363LP2300X | Nurse Practitioner - Primary Care | APRN.CNP.019572 | OH |
NPI | 1043764830 |
---|---|
Provider Name | Kelly O'brien Miller |
First Address | Columbus, OH 43205-2664 |
Second Address | Columbus, OH 43205 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 09/08/2016 |
Last Update Date | 05/12/2019 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
0188102 | (05) | OH |
H524110 | CGS MEDICARE (01) | OH |