Individual
KERI LONG MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PA-C
Contact information
Practice address
1165 DUNLAWTON AVE STE 105, PORT ORANGE, FL 32127-2924
(386) 425-4787
(386) 425-4788
Mailing address
303 N CLYDE MORRIS BLVD # 10E, PBFS DEPARTMENT, DAYTONA BEACH, FL 32114-2709
(386) 226-4590
(386) 425-6197
Taxonomy
Speciality
Code
Description
License number
State
363AM0700X
Medical Physician Assistant
Primary
PA 9108344
FL
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
013803400
—
FL
Enumeration date
11/11/2014
Last updated
07/21/2022
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