Miller, Kenneth Dominique
Miller, Kenneth Dominique is an individual health care provider with primary practice located at 875 Swift Blvd , Richland WA 99352-3592. He recently has 3 registered licenses in different health care specialties including Physician Assistants & Advanced Practice Nursing Providers / Medical, Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant, Physician Assistants & Advanced Practice Nursing Providers / Surgical. Physician Assistants & Advanced Practice Nursing Providers / Surgical is his primary health care specialty. Miller, Kenneth Dominique can be contacted via phone (509) 946-1654.Contact Information
Primary practice address
875 Swift Blvd
Richland WA 99352-3592
Phone: (509) 946-1654
Fax: (509) 943-5652
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Physician Assistants & Advanced Practice Nursing Providers / Medical | 363AM0700X | PA60115570 | Washington |
| Physician Assistants & Advanced Practice Nursing Providers / Physician Assistant | 363A00000X | PA60115570 | Washington |
| Physician Assistants & Advanced Practice Nursing Providers / Surgical | 363AS0400X | PA60115570 | Washington |
Profile Details
| NPI number | 1275868572 |
|---|---|
| LBN Legal business name | Miller, Kenneth Dominique |
| Credentials | Physician's Assistant Certified (PA-C) |
| Entity | Individual |
| Sole proprietor 1 | No |
| Enumeration date | Oct 5th, 2009 |
| Last updated | Jan 23rd, 2017 - about 8 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1275868572 | NPPES |
| Washington | MEDICAID | 2004006 | |
| Washington | Other | 0255435 | |
| Washington | Other | 0016MI | |
| Washington | MEDICAID | 500619959 | |
| Washington | MEDICAID | 808497500 | |
| Washington | Other | P00781687 |
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