Provider Demographics
NPI:1689282295
Name:MILLER, JORDAN LINDSEY (NP)
Entity Type:Individual
Prefix:
First Name:JORDAN
Middle Name:LINDSEY
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:231 MEDICAL PARK DR STE 300
Mailing Address - Street 2:
Mailing Address - City:BLUEFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:24605-1531
Mailing Address - Country:US
Mailing Address - Phone:276-322-5400
Mailing Address - Fax:276-322-5557
Practice Address - Street 1:231 MEDICAL PARK DR STE 300
Practice Address - Street 2:
Practice Address - City:BLUEFIELD
Practice Address - State:VA
Practice Address - Zip Code:24605-1531
Practice Address - Country:US
Practice Address - Phone:276-322-5400
Practice Address - Fax:276-322-5557
Is Sole Proprietor?:No
Enumeration Date:2020-07-20
Last Update Date:2020-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0024179771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily