Provider Demographics
NPI:1790235000
Name:MILLER, DUSTIN JOSEPH (NP-C)
Entity Type:Individual
Prefix:MR
First Name:DUSTIN
Middle Name:JOSEPH
Last Name:MILLER
Suffix:
Gender:M
Credentials:NP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1119 PRUDHOMME CIR STE F
Mailing Address - Street 2:
Mailing Address - City:OPELOUSAS
Mailing Address - State:LA
Mailing Address - Zip Code:70570-6516
Mailing Address - Country:US
Mailing Address - Phone:337-942-5899
Mailing Address - Fax:337-585-2674
Practice Address - Street 1:414 SAIZON ST
Practice Address - Street 2:
Practice Address - City:PORT BARRE
Practice Address - State:LA
Practice Address - Zip Code:70577
Practice Address - Country:US
Practice Address - Phone:337-447-4027
Practice Address - Fax:337-585-2674
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-11
Last Update Date:2019-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP09016363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily