Provider Demographics
NPI:1902033830
Name:MILLER, MISTY JO (PA-BC)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:JO
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-BC
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Mailing Address - Street 1:601 JOHN ST
Mailing Address - Street 2:SUITE E-352
Mailing Address - City:KALAMAZOO
Mailing Address - State:MI
Mailing Address - Zip Code:49007-5341
Mailing Address - Country:US
Mailing Address - Phone:269-341-8986
Mailing Address - Fax:269-341-6236
Practice Address - Street 1:601 JOHN ST
Practice Address - Street 2:SUITE E352
Practice Address - City:KALAMAZOO
Practice Address - State:MI
Practice Address - Zip Code:49007-5341
Practice Address - Country:US
Practice Address - Phone:269-341-8986
Practice Address - Fax:269-341-6236
Is Sole Proprietor?:No
Enumeration Date:2009-06-18
Last Update Date:2023-11-27
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Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1902033830Medicaid
MI1417961137OtherBCBSM BRONSON
MI1417961137OtherBCBSM BRONSON