Provider Demographics
NPI:1326805078
Name:MILLER, JORDYN LEIGH
Entity Type:Individual
Prefix:
First Name:JORDYN
Middle Name:LEIGH
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:JORDYN
Other - Middle Name:LEIGH
Other - Last Name:DEVERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:66 SAN PEDRO DR
Mailing Address - Street 2:
Mailing Address - City:COLONIAL BEACH
Mailing Address - State:VA
Mailing Address - Zip Code:22443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:10 STAFFORD LAKES PKWY STE 102
Practice Address - Street 2:
Practice Address - City:FREDERICKSBURG
Practice Address - State:VA
Practice Address - Zip Code:22406-7305
Practice Address - Country:US
Practice Address - Phone:540-741-6982
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-29
Last Update Date:2024-02-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024189602363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily