Basic Information
| Provider Information | |||||||||
| NPI: | 1689882755 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | KIMBERLEY | ||||||||
| MiddleName: | ANNE | ||||||||
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| Credential: | RN, GNNP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 11134 ROUND MOUNTAIN DR | ||||||||
| Address2: | |||||||||
| City: | FRISCO | ||||||||
| State: | TX | ||||||||
| PostalCode: | 750359017 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9727123524 | ||||||||
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| Practice Location | |||||||||
| Address1: | 1301 CONCORD TER | ||||||||
| Address2: | PEDIATRIX MEDICAL GROUP | ||||||||
| City: | SUNRISE | ||||||||
| State: | FL | ||||||||
| PostalCode: | 333232843 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9543840175 | ||||||||
| FaxNumber: | 8777804242 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/20/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 163WN0002X | 638622 | TX | Y | Nursing Service Providers | Registered Nurse | Neonatal Intensive Care |
No ID Information.