Individual
KENDALL C. MILLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
C.R.N.A
Contact information
Practice address
1737 BRIARCREST DR, STE 14, BRYAN, TX 77802-2739
(979) 776-4777
(979) 776-0588
Mailing address
1737 BRIARCREST DR, STE 14, BRYAN, TX 77802-2739
(979) 776-4777
(979) 776-0588
Taxonomy
Speciality
Code
Description
License number
State
367500000X
Certified Registered Nurse Anesthetist
Primary
AP111279
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
000010146567
BLUE SHIELD
ID
01
—
HBPTO
BLUE CROSS
ID
05
—
M8068633
—
ID
Enumeration date
11/29/2006
Last updated
04/06/2017
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