Provider Demographics
NPI:1679232581
Name:MILLER, RITA BLACKWELL (APRN)
Entity Type:Individual
Prefix:
First Name:RITA
Middle Name:BLACKWELL
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5912 WESTMINSTER
Mailing Address - Street 2:
Mailing Address - City:BENTON
Mailing Address - State:AR
Mailing Address - Zip Code:72019-6653
Mailing Address - Country:US
Mailing Address - Phone:404-554-7100
Mailing Address - Fax:
Practice Address - Street 1:5912 WESTMINSTER
Practice Address - Street 2:
Practice Address - City:BENTON
Practice Address - State:AR
Practice Address - Zip Code:72019-6653
Practice Address - Country:US
Practice Address - Phone:404-554-7100
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-08
Last Update Date:2021-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR217688363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care