Provider Demographics
NPI:1629532122
Name:MILLER, SHARONDA RENEE (FNP)
Entity Type:Individual
Prefix:
First Name:SHARONDA
Middle Name:RENEE
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 1:899 MARTIN LUTHER KING JR DR
Mailing Address - Street 2:
Mailing Address - City:MINERAL SPRINGS
Mailing Address - State:AR
Mailing Address - Zip Code:71851-9044
Mailing Address - Country:US
Mailing Address - Phone:870-703-3034
Mailing Address - Fax:
Practice Address - Street 1:116 S MAIN ST
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:AR
Practice Address - Zip Code:71852-2406
Practice Address - Country:US
Practice Address - Phone:870-455-0256
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-01-29
Last Update Date:2023-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA006086363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily