Provider Demographics
NPI:1790133940
Name:MILLER, MICHELLE JENKINS
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:JENKINS
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:PO BOX 72
Mailing Address - Street 2:
Mailing Address - City:LA PLACE
Mailing Address - State:LA
Mailing Address - Zip Code:70069-0072
Mailing Address - Country:US
Mailing Address - Phone:985-224-2888
Mailing Address - Fax:985-224-2994
Practice Address - Street 1:1 ORMOND BLVD STE B
Practice Address - Street 2:
Practice Address - City:LA PLACE
Practice Address - State:LA
Practice Address - Zip Code:70068
Practice Address - Country:US
Practice Address - Phone:985-224-2998
Practice Address - Fax:985-224-2995
Is Sole Proprietor?:Yes
Enumeration Date:2016-05-27
Last Update Date:2018-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator