Provider Demographics
NPI:1326323767
Name:MILLER, JULIE KATHRYN (FNP)
Entity Type:Individual
Prefix:MS
First Name:JULIE
Middle Name:KATHRYN
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP
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Mailing Address - Street 1:12101 WOODCREST EXECUTIVE DR
Mailing Address - Street 2:SUITE 210
Mailing Address - City:SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63141-5047
Mailing Address - Country:US
Mailing Address - Phone:314-317-0600
Mailing Address - Fax:314-317-0606
Practice Address - Street 1:100 MEDICAL PLZ
Practice Address - Street 2:
Practice Address - City:LAKE ST LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-1366
Practice Address - Country:US
Practice Address - Phone:314-317-0600
Practice Address - Fax:314-317-0606
Is Sole Proprietor?:No
Enumeration Date:2011-10-17
Last Update Date:2014-06-18
Deactivation Date:
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Provider Licenses
StateLicense IDTaxonomies
MO2011034264363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1326323767Medicaid
MO139000110Medicare PIN