Provider Demographics
NPI:1265925358
Name:MILLER, JENNIFER MITCHELL (NP)
Entity type:Individual
Prefix:
First Name:JENNIFER
Middle Name:MITCHELL
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:JENNIFER
Other - Middle Name:MARIE
Other - Last Name:MITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 741836
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30374-1836
Mailing Address - Country:US
Mailing Address - Phone:901-348-1281
Mailing Address - Fax:
Practice Address - Street 1:2120 EXETER RD STE 250
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:TN
Practice Address - Zip Code:38138-3931
Practice Address - Country:US
Practice Address - Phone:901-767-5864
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-06-13
Last Update Date:2024-09-12
Deactivation Date:2019-01-17
Deactivation Code:
Reactivation Date:2019-02-13
Provider Licenses
StateLicense IDTaxonomies
TN225950363LF0000X
TN23657363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily