Provider Demographics
NPI:1134891062
Name:MILLER, JOCELYN BROOKE
Entity type:Individual
Prefix:
First Name:JOCELYN
Middle Name:BROOKE
Last Name:MILLER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9162 COUNTY RD
Mailing Address - Street 2:
Mailing Address - City:BLUE RIDGE
Mailing Address - State:TX
Mailing Address - Zip Code:75424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:3700 W 15TH ST STE 200B
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75075-4729
Practice Address - Country:US
Practice Address - Phone:972-398-0261
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2165392208100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes208100000XAllopathic & Osteopathic PhysiciansPhysical Medicine & Rehabilitation