Active NPI
Kelli Henderhan Miller, NP
- Nurse Practitioner
- Canton, OH
National Provider Identifier
1306054895
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Nurse Practitioner
- License
- RN235076
- Practice address
- 128 Wertz Ave NW
Suite B
Canton, OH 44708-4145 - Phone
- (330) 452-9460
- NPI assigned
- May 18, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Nurse Practitioner | 363L00000X | RN235076 | OH | Primary |
Addresses
Primary practice location
128 Wertz Ave NW
Suite B
Canton, OH 44708-4145
Mailing address
2600 15TH St NW
Canton, OH 44708-3123
Phone (330) 452-3375
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Enrolled
- Credentials
- Certified Nurse Practitioner, Nurse Practitioner
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| RN235076 | OH | MD | Nurse Practitioner |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179446400000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1306054895",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2600 15TH ST NW",
"city": "CANTON",
"state": "OH",
"postal_code": "447083123",
"telephone_number": "330-452-3375"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "128 WERTZ AVE NW",
"address_2": "SUITE B",
"city": "CANTON",
"state": "OH",
"postal_code": "447084145",
"telephone_number": "330-452-9460"
}
],
"practiceLocations": [],
"basic": {
"last_name": "HENDERHAN MILLER",
"first_name": "KELLI",
"credential": "NP",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-18",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "363L00000X",
"taxonomy_group": "",
"desc": "Nurse Practitioner",
"state": "OH",
"license": "RN235076",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Canton, OH
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.