Provider Demographics
NPI:1679523146
Name:MILLER, TRACEY M (ARNP MSN)
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:M
Last Name:MILLER
Suffix:
Gender:F
Credentials:ARNP MSN
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Other - Credentials:
Mailing Address - Street 1:PO BOX 776351
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60677-6351
Mailing Address - Country:US
Mailing Address - Phone:502-588-9490
Mailing Address - Fax:502-272-5116
Practice Address - Street 1:4123 DUTCHMANS LN
Practice Address - Street 2:STE.301
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40207
Practice Address - Country:US
Practice Address - Phone:502-896-2500
Practice Address - Fax:502-896-2527
Is Sole Proprietor?:No
Enumeration Date:2006-05-12
Last Update Date:2021-01-20
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Provider Licenses
StateLicense IDTaxonomies
KY1075730363LN0000X
KY3002906363LN0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LN0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerNeonatal