1831515998 NPI number — MRS. KRISTEN BENNETT MILLER RN, MSN

Table of content: MRS. KRISTEN BENNETT MILLER RN, MSN (NPI 1831515998)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1831515998 NPI number — MRS. KRISTEN BENNETT MILLER RN, MSN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
KRISTEN
Provider Middle Name:
BENNETT
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
RN, MSN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1831515998
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/13/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
113 LYNDALE DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
HARTSVILLE
Provider Business Mailing Address State Name:
SC
Provider Business Mailing Address Postal Code:
29550-4613
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
843-673-6536
Provider Business Mailing Address Fax Number:
843-661-4859

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
145 E CHEVES ST
Provider Second Line Business Practice Location Address:
PEE DEE PUBLIC HEALTH REGION
Provider Business Practice Location Address City Name:
FLORENCE
Provider Business Practice Location Address State Name:
SC
Provider Business Practice Location Address Postal Code:
29506-2526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
843-661-4830
Provider Business Practice Location Address Fax Number:
843-661-4859
Provider Enumeration Date:
03/13/2014

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: 163WC0400X , with the licence number:  96128 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 163WC1500X , with the licence number: 96128 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 163WA2000X , with the licence number: 96128 , registered in the state of SC ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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