Provider Demographics
NPI:1225441983
Name:MINER, SEIRRA NICOLE I
Entity Type:Individual
Prefix:MISS
First Name:SEIRRA
Middle Name:NICOLE
Last Name:MINER
Suffix:I
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:SEIRRA
Other - Middle Name:NICOLE
Other - Last Name:MINER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:641 WEST ST.
Mailing Address - Street 2:
Mailing Address - City:LUXORA
Mailing Address - State:AR
Mailing Address - Zip Code:72358
Mailing Address - Country:US
Mailing Address - Phone:870-815-0630
Mailing Address - Fax:
Practice Address - Street 1:641 WEST ST.
Practice Address - Street 2:
Practice Address - City:LUXORA
Practice Address - State:AR
Practice Address - Zip Code:72358
Practice Address - Country:US
Practice Address - Phone:870-815-0630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-06-10
Last Update Date:2014-06-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR932555772171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator