Provider Demographics
NPI:1619423472
Name:MILLER, FAITH MELINDA (PMHNP-BC)
Entity Type:Individual
Prefix:
First Name:FAITH
Middle Name:MELINDA
Last Name:MILLER
Suffix:
Gender:F
Credentials:PMHNP-BC
Other - Prefix:
Other - First Name:FAITH
Other - Middle Name:MELINDA
Other - Last Name:PANGBURN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:RN
Mailing Address - Street 1:2526 E 71ST ST STE J
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5576
Mailing Address - Country:US
Mailing Address - Phone:918-268-9578
Mailing Address - Fax:918-471-2854
Practice Address - Street 1:2526 E 71ST ST STE J
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-5576
Practice Address - Country:US
Practice Address - Phone:918-268-9578
Practice Address - Fax:918-471-2854
Is Sole Proprietor?:No
Enumeration Date:2016-08-31
Last Update Date:2023-10-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK105704163WG0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WG0000XNursing Service ProvidersRegistered NurseGeneral Practice
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200849990AMedicaid