Provider Demographics
NPI:1508510082
Name:MILLER, JESSICA RACHELLE (NP)
Entity Type:Individual
Prefix:
First Name:JESSICA
Middle Name:RACHELLE
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2588 S SALEM RD
Mailing Address - Street 2:
Mailing Address - City:LIBERTY
Mailing Address - State:IN
Mailing Address - Zip Code:47353-8905
Mailing Address - Country:US
Mailing Address - Phone:765-580-0342
Mailing Address - Fax:
Practice Address - Street 1:1050 REID PKWY STE 325
Practice Address - Street 2:
Practice Address - City:RICHMOND
Practice Address - State:IN
Practice Address - Zip Code:47374-1161
Practice Address - Country:US
Practice Address - Phone:765-962-8551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-02-04
Last Update Date:2024-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN28207662A163W00000X
IN71012580A363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse