Provider Demographics
NPI:1275941213
Name:MILLER, BEVERLY ELAINE (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BEVERLY
Middle Name:ELAINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4882 SOCASTEE BLVD
Mailing Address - Street 2:
Mailing Address - City:MYRTLE BEACH
Mailing Address - State:SC
Mailing Address - Zip Code:29588-7245
Mailing Address - Country:US
Mailing Address - Phone:843-668-2744
Mailing Address - Fax:
Practice Address - Street 1:4882 SOCASTEE BLVD STE 201
Practice Address - Street 2:
Practice Address - City:MYRTLE BEACH
Practice Address - State:SC
Practice Address - Zip Code:29588-7245
Practice Address - Country:US
Practice Address - Phone:843-668-2744
Practice Address - Fax:843-668-2742
Is Sole Proprietor?:No
Enumeration Date:2014-07-22
Last Update Date:2021-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC18928363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
SC1306907613OtherNPI