Provider Demographics
NPI:1497305023
Name:MILLER, AUDRA DANIELLE (RD, LDN)
Entity Type:Individual
Prefix:
First Name:AUDRA
Middle Name:DANIELLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RD, LDN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1830 LAKESIDE DR
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:NC
Mailing Address - Zip Code:28734-6778
Mailing Address - Country:US
Mailing Address - Phone:828-349-2081
Mailing Address - Fax:
Practice Address - Street 1:1830 LAKESIDE DR
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:NC
Practice Address - Zip Code:28734-6778
Practice Address - Country:US
Practice Address - Phone:828-349-2081
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2019-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCL001345133V00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes133V00000XDietary & Nutritional Service ProvidersDietitian, Registered