Provider Demographics
NPI:1942252093
Name:MILLER, MADELYN (APN BC)
Entity Type:Individual
Prefix:
First Name:MADELYN
Middle Name:
Last Name:MILLER
Suffix:
Gender:F
Credentials:APN BC
Other - Prefix:
Other - First Name:MADELYN
Other - Middle Name:MILLER
Other - Last Name:DARBONNE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:201 N CANAL BLVD
Mailing Address - Street 2:
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-2910
Mailing Address - Country:US
Mailing Address - Phone:866-389-2727
Mailing Address - Fax:
Practice Address - Street 1:2105 CLEARY AVE
Practice Address - Street 2:
Practice Address - City:METAIRIE
Practice Address - State:LA
Practice Address - Zip Code:70001-1623
Practice Address - Country:US
Practice Address - Phone:419-841-1832
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2019-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP03086363LF0000X
OH15101-NP363LF0000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI11-4946473Medicaid
MI4863521Medicaid
MI11-4946464Medicaid
MI11-4946482Medicaid
MI4863503Medicaid
MI4863497Medicaid
MI11-4946455Medicaid
MI382962430001OtherTRICARE CHAMPUS
MI4863512Medicaid
MI4863530Medicaid
MI4863512Medicaid
MI4863512Medicaid
MI5008669850Medicare PIN