Provider Demographics
NPI:1538677497
Name:MILLER, ALLISON ELAINE (FNP)
Entity Type:Individual
Prefix:
First Name:ALLISON
Middle Name:ELAINE
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2372 GLENN DR
Mailing Address - Street 2:
Mailing Address - City:ARNOLD
Mailing Address - State:MO
Mailing Address - Zip Code:63010-2231
Mailing Address - Country:US
Mailing Address - Phone:314-605-2055
Mailing Address - Fax:
Practice Address - Street 1:621 S NEW BALLAS RD STE 5003B
Practice Address - Street 2:
Practice Address - City:SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63141-8270
Practice Address - Country:US
Practice Address - Phone:314-251-8892
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-01-12
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL041452357163W00000X
MO143620163W00000X
IL209018354363LF0000X
MO2018006687363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163W00000XNursing Service ProvidersRegistered Nurse