Provider Demographics
NPI:1154089803
Name:MILLER, MELINDA D
Entity Type:Individual
Prefix:
First Name:MELINDA
Middle Name:D
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:106 S 3RD ST
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5300
Mailing Address - Country:US
Mailing Address - Phone:918-429-2955
Mailing Address - Fax:
Practice Address - Street 1:106 S 3RD
Practice Address - Street 2:MCALESTER
Practice Address - City:OKLAHOMA
Practice Address - State:OK
Practice Address - Zip Code:74501
Practice Address - Country:US
Practice Address - Phone:918-429-2955
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-30
Last Update Date:2021-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator