Provider Demographics
NPI:1679613855
Name:MILLER, CHERYL (ARNP)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2725 JAMES SANDERS BLVD
Mailing Address - Street 2:SUITE A
Mailing Address - City:PADUCAH
Mailing Address - State:KY
Mailing Address - Zip Code:42001-8401
Mailing Address - Country:US
Mailing Address - Phone:270-554-5114
Mailing Address - Fax:
Practice Address - Street 1:2725 JAMES SANDERS BLVD
Practice Address - Street 2:SUITE A
Practice Address - City:PADUCAH
Practice Address - State:KY
Practice Address - Zip Code:42001-8401
Practice Address - Country:US
Practice Address - Phone:270-554-5114
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-07
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY1008134363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY00001002Medicare PIN
KY0392807Medicare PIN
KYP00647644Medicare PIN
KYQ36280Medicare UPIN