Provider Demographics
NPI:1144194432
Name:MILLER, TRACEY D
Entity type:Individual
Prefix:
First Name:TRACEY
Middle Name:D
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TRACEY
Other - Middle Name:DAWN
Other - Last Name:HENRIES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 207
Mailing Address - Street 2:
Mailing Address - City:WAVERLY
Mailing Address - State:WV
Mailing Address - Zip Code:26184-0207
Mailing Address - Country:US
Mailing Address - Phone:304-834-4619
Mailing Address - Fax:
Practice Address - Street 1:700 VIRGINIA STREET
Practice Address - Street 2:
Practice Address - City:WAVERLY
Practice Address - State:WV
Practice Address - Zip Code:26184-8172
Practice Address - Country:US
Practice Address - Phone:304-834-4619
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-10-01
Last Update Date:2025-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes374U00000XNursing Service Related ProvidersHome Health Aide