Provider Demographics
NPI:1265238661
Name:MILLER, AUDREY (QBHP)
Entity type:Individual
Prefix:
First Name:AUDREY
Middle Name:
Last Name:MILLER
Suffix:
Gender:
Credentials:QBHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 FRANKIE LN
Mailing Address - Street 2:
Mailing Address - City:WHITE HALL
Mailing Address - State:AR
Mailing Address - Zip Code:71602-2685
Mailing Address - Country:US
Mailing Address - Phone:870-247-3588
Mailing Address - Fax:870-247-2072
Practice Address - Street 1:109 FRANKIE LN
Practice Address - Street 2:
Practice Address - City:WHITE HALL
Practice Address - State:AR
Practice Address - Zip Code:71602-2685
Practice Address - Country:US
Practice Address - Phone:870-247-3588
Practice Address - Fax:870-247-2072
Is Sole Proprietor?:No
Enumeration Date:2025-02-25
Last Update Date:2025-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator