Provider Demographics
NPI:1770671331
Name:MILLER, ANGELA C (NP)
Entity Type:Individual
Prefix:MRS
First Name:ANGELA
Middle Name:C
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:919 HIDDEN RDG
Mailing Address - Street 2:
Mailing Address - City:IRVING
Mailing Address - State:TX
Mailing Address - Zip Code:75038-3813
Mailing Address - Country:US
Mailing Address - Phone:469-282-2711
Mailing Address - Fax:469-282-0996
Practice Address - Street 1:1701 JIMMIE DAVIS HWY
Practice Address - Street 2:SUITE 200
Practice Address - City:BOSSIER CITY
Practice Address - State:LA
Practice Address - Zip Code:71112-4515
Practice Address - Country:US
Practice Address - Phone:318-681-1660
Practice Address - Fax:318-681-1661
Is Sole Proprietor?:No
Enumeration Date:2006-10-10
Last Update Date:2016-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAPO4571363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1478491Medicaid
LA1478491Medicaid