Provider Demographics
NPI:1053319947
Name:MILLER, KIM PATRICIA (PHD)
Entity type:Individual
Prefix:DR
First Name:KIM
Middle Name:PATRICIA
Last Name:MILLER
Suffix:
Gender:
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:23 WINTHROP DR
Mailing Address - Street 2:
Mailing Address - City:SHARPSBURG
Mailing Address - State:GA
Mailing Address - Zip Code:30277-2285
Mailing Address - Country:US
Mailing Address - Phone:347-204-4629
Mailing Address - Fax:470-414-1096
Practice Address - Street 1:19 W 24TH ST
Practice Address - Street 2:
Practice Address - City:NEW YORK
Practice Address - State:NY
Practice Address - Zip Code:10010-3203
Practice Address - Country:US
Practice Address - Phone:929-602-2026
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-07-13
Last Update Date:2025-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY016390103G00000X, 103TC0700X
GAPSY004728103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist