Provider Demographics
NPI:1518361922
Name:MILLER, EDGAR (FNP-C)
Entity Type:Individual
Prefix:MR
First Name:EDGAR
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 PECAN HILL DR
Mailing Address - Street 2:APT 15
Mailing Address - City:CLINTON
Mailing Address - State:MS
Mailing Address - Zip Code:39056-5250
Mailing Address - Country:US
Mailing Address - Phone:601-383-1592
Mailing Address - Fax:
Practice Address - Street 1:200 PECAN HILL DR
Practice Address - Street 2:APT 15
Practice Address - City:CLINTON
Practice Address - State:MS
Practice Address - Zip Code:39056-5250
Practice Address - Country:US
Practice Address - Phone:601-383-1592
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-14
Last Update Date:2014-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MSR878296363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily