Provider Demographics
NPI:1629510391
Name:MILLER, ANITA (FNP-C)
Entity Type:Individual
Prefix:MS
First Name:ANITA
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
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 1:2400 LUCY LEE PKWY STE F
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2427
Mailing Address - Country:US
Mailing Address - Phone:573-609-2266
Mailing Address - Fax:573-785-0947
Practice Address - Street 1:2400 LUCY LEE PKWY STE F
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2427
Practice Address - Country:US
Practice Address - Phone:573-609-2266
Practice Address - Fax:573-785-0947
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-13
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004019761363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily