Provider Demographics
NPI:1275295792
Name:MILLER, VIRGINIA (CNP)
Entity Type:Individual
Prefix:MRS
First Name:VIRGINIA
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 1:703 ALCORN DR STE 109
Mailing Address - Street 2:
Mailing Address - City:CORINTH
Mailing Address - State:MS
Mailing Address - Zip Code:38834-9302
Mailing Address - Country:US
Mailing Address - Phone:662-286-1499
Mailing Address - Fax:
Practice Address - Street 1:3037 CORDER DR
Practice Address - Street 2:
Practice Address - City:CORINTH
Practice Address - State:MS
Practice Address - Zip Code:38834-6216
Practice Address - Country:US
Practice Address - Phone:662-284-8565
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-12
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS904949363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily