Provider Demographics
NPI:1235124603
Name:MILLER, JENNIFER REBECCA (ARNP)
Entity Type:Individual
Prefix:
First Name:JENNIFER
Middle Name:REBECCA
Last Name:MILLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:REBECCA
Other - Last Name:JONES
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 6671
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80934-6671
Mailing Address - Country:US
Mailing Address - Phone:198-001-1183
Mailing Address - Fax:
Practice Address - Street 1:3439 SE HAWTHORNE BLVD # 1108
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97214-5048
Practice Address - Country:US
Practice Address - Phone:971-319-4411
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2005-09-13
Last Update Date:2021-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CORN.1620338163W00000X
TNRN0000143941363LF0000X
WAAP30008007363LF0000X, 363LP0808X
TNAPN0000010435363LF0000X
COAPN.0990660-NP363LF0000X, 363LP0808X
OR201705366363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily