Provider Demographics
NPI:1083756803
Name:MILLER, NAOMI (CNP)
Entity Type:Individual
Prefix:
First Name:NAOMI
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 37
Mailing Address - Street 2:
Mailing Address - City:MELBOURNE
Mailing Address - State:AR
Mailing Address - Zip Code:72556-0037
Mailing Address - Country:US
Mailing Address - Phone:870-368-4344
Mailing Address - Fax:870-368-3051
Practice Address - Street 1:1526 MAIN
Practice Address - Street 2:
Practice Address - City:MELBOURNE
Practice Address - State:AR
Practice Address - Zip Code:72556-0037
Practice Address - Country:US
Practice Address - Phone:870-368-4344
Practice Address - Fax:870-368-3051
Is Sole Proprietor?:No
Enumeration Date:2007-02-12
Last Update Date:2014-10-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA01226363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
G12501Medicare UPIN