Provider Demographics
NPI:1790296622
Name:MILLER, DAPHANE (PMHNP)
Entity Type:Individual
Prefix:
First Name:DAPHANE
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:PMHNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:739 BLUFF CITY HWY STE 3
Mailing Address - Street 2:
Mailing Address - City:BRISTOL
Mailing Address - State:TN
Mailing Address - Zip Code:37620-4637
Mailing Address - Country:US
Mailing Address - Phone:423-534-9195
Mailing Address - Fax:833-558-0823
Practice Address - Street 1:739 BLUFF CITY HWY STE 3
Practice Address - Street 2:
Practice Address - City:BRISTOL
Practice Address - State:TN
Practice Address - Zip Code:37620-4637
Practice Address - Country:US
Practice Address - Phone:423-534-9195
Practice Address - Fax:423-844-0360
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-18
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN23141363LP0808X
VA24175442363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health