Provider Demographics
NPI:1184646630
Name:MILLER, JAMIE T (APRN)
Entity Type:Individual
Prefix:
First Name:JAMIE
Middle Name:T
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:JAMIE
Other - Middle Name:T
Other - Last Name:LYNCH
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:APRN
Mailing Address - Street 1:200 CLINIC DR
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-1661
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:800 HOSPITAL DR
Practice Address - Street 2:
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431-1658
Practice Address - Country:US
Practice Address - Phone:270-326-3800
Practice Address - Fax:270-326-3805
Is Sole Proprietor?:No
Enumeration Date:2006-07-24
Last Update Date:2015-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY3004327363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000343427OtherBCBS PROVIDER NUMBER
KY78012788Medicaid
KYP01198573OtherRAILROAD MEDICARE WALMART LOCATION
KY718788OtherANTHEM- WALMART CLINIC MVILLE
KYK120341Medicare PIN
0683226Medicare PIN
0601420Medicare PIN
0771910Medicare PIN
KY78012788Medicaid
0375399Medicare PIN
KYK120340Medicare PIN
0396845Medicare PIN
KY718788OtherANTHEM- WALMART CLINIC MVILLE
KYP01198573OtherRAILROAD MEDICARE WALMART LOCATION
KYP400032160Medicare PIN
0935802Medicare PIN
000000343427OtherBCBS PROVIDER NUMBER
KYQ24122Medicare UPIN
KYP400036416Medicare PIN