Provider Demographics
NPI:1710024179
Name:MILLER, RUBY SHEREE (DNP, FNP-BC)
Entity Type:Individual
Prefix:MRS
First Name:RUBY
Middle Name:SHEREE
Last Name:MILLER
Suffix:
Gender:F
Credentials:DNP, FNP-BC
Other - Prefix:
Other - First Name:RUBY
Other - Middle Name:VERNON
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:DNP, FNP
Mailing Address - Street 1:15825 PROFESSIONAL PLZ
Mailing Address - Street 2:SUITE C
Mailing Address - City:HAMMOND
Mailing Address - State:LA
Mailing Address - Zip Code:70403-1497
Mailing Address - Country:US
Mailing Address - Phone:985-662-5723
Mailing Address - Fax:985-662-5718
Practice Address - Street 1:15825 PROFESSIONAL PLZ
Practice Address - Street 2:SUITE C
Practice Address - City:HAMMOND
Practice Address - State:LA
Practice Address - Zip Code:70403-1497
Practice Address - Country:US
Practice Address - Phone:985-662-5723
Practice Address - Fax:985-662-5718
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-01
Last Update Date:2017-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04833363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1000426Medicaid
3A151Medicare PIN