Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207Q00000X | Family Doctor | OT014300 | PA |
Y | 207QG0300X | Family Doctor - Geriatric Medicine | OP60546764 | WA |
NPI | 1336432103 |
---|---|
Provider Name | Kimberly Jane Miller |
First Address | Kennewick, WA 99336-5011 |
Second Address | Richland, WA 99352-8703 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 26/05/2011 |
Last Update Date | 26/11/2021 |