Provider Demographics
NPI:1497789945
Name:MILLER-FRITZ, JAYNE E (MS)
Entity Type:Individual
Prefix:MRS
First Name:JAYNE
Middle Name:E
Last Name:MILLER-FRITZ
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1103 N. EASTMAN RD.
Mailing Address - Street 2:
Mailing Address - City:KINGSPORT
Mailing Address - State:TN
Mailing Address - Zip Code:37664
Mailing Address - Country:US
Mailing Address - Phone:423-247-5771
Mailing Address - Fax:423-247-5775
Practice Address - Street 1:1103 N. EASTMAN RD.
Practice Address - Street 2:
Practice Address - City:KINGSPORT
Practice Address - State:TN
Practice Address - Zip Code:37664
Practice Address - Country:US
Practice Address - Phone:423-247-5771
Practice Address - Fax:423-247-5775
Is Sole Proprietor?:No
Enumeration Date:2006-07-10
Last Update Date:2020-02-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000198231H00000X
TN000198231H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes231H00000XSpeech, Language and Hearing Service ProvidersAudiologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010211956OtherVIRGINIA MEDICAID
103I649360OtherMEDICARE ID TYPE UNSPECIFIED
TN151887Medicaid
4245432OtherBCBS
TN621156919OtherTAX ID#