Provider Demographics
NPI:1851381198
Name:MILLER, STEPHEN (ACNP)
Entity Type:Individual
Prefix:MR
First Name:STEPHEN
Middle Name:
Last Name:MILLER
Suffix:
Gender:M
Credentials:ACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10800 PARKSIDE DR STE 331
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37934-1922
Mailing Address - Country:US
Mailing Address - Phone:865-392-3400
Mailing Address - Fax:865-392-3449
Practice Address - Street 1:10800 PARKSIDE DR STE 331
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37934-1922
Practice Address - Country:US
Practice Address - Phone:865-392-3400
Practice Address - Fax:865-392-3449
Is Sole Proprietor?:No
Enumeration Date:2005-10-27
Last Update Date:2020-09-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN7867363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1519772Medicaid
TN103I506530Medicare PIN
P00841551Medicare PIN
TNS94495Medicare UPIN
500013921Medicare PIN
TN103I500801Medicare PIN
TN3905212Medicare PIN