1104076637 NPI number — MRS. KARI A MILLER PMHNP

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1104076637 NPI number — MRS. KARI A MILLER PMHNP

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
KARI
Provider Middle Name:
A
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
PMHNP
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
OBRIEN
Provider Other First Name:
KARI
Provider Other Middle Name:
A
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1104076637
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/23/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 E. SOUTHERN AVE
Provider Second Line Business Mailing Address:
STE. 735
Provider Business Mailing Address City Name:
TEMPE
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85282-2692
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
480-804-0326
Provider Business Mailing Address Fax Number:
480-804-0083

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2120 S MCCLINTOCK DR
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
TEMPE
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85282-2692
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
480-804-0326
Provider Business Practice Location Address Fax Number:
480-804-0083
Provider Enumeration Date:
09/20/2008

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0808X , with the licence number:  AP3164 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: Z142664 . This is a "MEDICARE" identifier , issued by the state of ( AZ ) . This identifiers is of the category "OTHER".
  • Identifier: 371595 , issued by the state of ( AZ ) . This identifiers is of the category "MEDICAID".




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