Provider Demographics
NPI:1336141001
Name:MILLER, MELINDA BETH (CRNA)
Entity Type:Individual
Prefix:MRS
First Name:MELINDA
Middle Name:BETH
Last Name:MILLER
Suffix:
Gender:F
Credentials:CRNA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1324 BROWN ST
Mailing Address - Street 2:SUITE 600
Mailing Address - City:WAXAHACHIE
Mailing Address - State:TX
Mailing Address - Zip Code:75165-1421
Mailing Address - Country:US
Mailing Address - Phone:972-937-6277
Mailing Address - Fax:972-937-6288
Practice Address - Street 1:1324 BROWN ST
Practice Address - Street 2:SUITE 600
Practice Address - City:WAXAHACHIE
Practice Address - State:TX
Practice Address - Zip Code:75165-1421
Practice Address - Country:US
Practice Address - Phone:972-937-6277
Practice Address - Fax:972-937-6288
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-12
Last Update Date:2012-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX236996367500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes367500000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Anesthetist, Certified Registered
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1301376Medicaid
TX1301376Medicaid
00344TMedicare ID - Type Unspecified