Provider Demographics
NPI:1043889611
Name:MILLER, JODI (FNP/AGACNP)
Entity Type:Individual
Prefix:MRS
First Name:JODI
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP/AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1842 SIMPSON HIGHWAY 149
Mailing Address - Street 2:
Mailing Address - City:MENDENHALL
Mailing Address - State:MS
Mailing Address - Zip Code:39114-3438
Mailing Address - Country:US
Mailing Address - Phone:601-847-7130
Mailing Address - Fax:
Practice Address - Street 1:1842 SIMPSON HIGHWAY 149
Practice Address - Street 2:
Practice Address - City:MENDENHALL
Practice Address - State:MS
Practice Address - Zip Code:39114-3438
Practice Address - Country:US
Practice Address - Phone:601-847-7151
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-06-18
Last Update Date:2021-08-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSMILL-IKRK13363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily