Provider Demographics
NPI:1679358188
Name:MILLER, LASHELLL MARIE
Entity Type:Individual
Prefix:MS
First Name:LASHELLL
Middle Name:MARIE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:310 MID CONTINENT PLZ STE 604D
Mailing Address - Street 2:
Mailing Address - City:WEST MEMPHIS
Mailing Address - State:AR
Mailing Address - Zip Code:72301-1763
Mailing Address - Country:US
Mailing Address - Phone:870-394-9464
Mailing Address - Fax:
Practice Address - Street 1:310 MID CONTINENT PLZ STE 604D
Practice Address - Street 2:
Practice Address - City:WEST MEMPHIS
Practice Address - State:AR
Practice Address - Zip Code:72301-1763
Practice Address - Country:US
Practice Address - Phone:870-394-9464
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-31
Last Update Date:2023-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center