Individual
MR. KENNETH DOMINIQUE MILLER
Active
Individual
MR. KENNETH DOMINIQUE MILLER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
PA-C
Taxonomy
Speciality
Code
Description
License number
State
363A00000X
Physician Assistant
PA60115570
WA
363AM0700X
Medical Physician Assistant
PA60115570
WA
363AS0400X
Surgical Physician Assistant
Primary
PA60115570
WA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0016MI
BSWA KADLEC
WA
01
—
0255435
LIWA VCR
WA
05
—
2004006
—
WA
05
—
500619959
—
OR
05
—
808497500
—
ID
01
—
P00781687
RRGA
WA
Enumeration date
10/05/2009
Last updated
01/23/2017
Update your record
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