Provider Demographics
NPI:1487202826
Name:MILLER, JODI LYNN (APRN)
Entity Type:Individual
Prefix:
First Name:JODI
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:61 29TH ST
Mailing Address - Street 2:
Mailing Address - City:WHEELING
Mailing Address - State:WV
Mailing Address - Zip Code:26003-4161
Mailing Address - Country:US
Mailing Address - Phone:304-233-9323
Mailing Address - Fax:304-233-3869
Practice Address - Street 1:61 29TH ST
Practice Address - Street 2:
Practice Address - City:WHEELING
Practice Address - State:WV
Practice Address - Zip Code:26003-4161
Practice Address - Country:US
Practice Address - Phone:304-233-1135
Practice Address - Fax:304-233-3869
Is Sole Proprietor?:No
Enumeration Date:2019-08-29
Last Update Date:2021-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WVAPRN51341207QA0401X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QA0401XAllopathic & Osteopathic PhysiciansFamily MedicineAddiction Medicine
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily