Provider Demographics
NPI:1285690222
Name:TAYLOR-MILLER, BERTHA (FNP)
Entity Type:Individual
Prefix:MRS
First Name:BERTHA
Middle Name:
Last Name:TAYLOR-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 1:211 BONNIE BROOK RD
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:NC
Mailing Address - Zip Code:28315-3125
Mailing Address - Country:US
Mailing Address - Phone:910-716-0099
Mailing Address - Fax:910-405-1359
Practice Address - Street 1:211 BONNIE BROOK RD
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:NC
Practice Address - Zip Code:28315
Practice Address - Country:US
Practice Address - Phone:910-716-0099
Practice Address - Fax:910-405-1359
Is Sole Proprietor?:Yes
Enumeration Date:2006-04-26
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC201746363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
NC7003729Medicaid
NC2592025BMedicare ID - Type Unspecified
NC7003729Medicaid