Provider Demographics
NPI:1457778151
Name:MILLER, BETH ELISHA (PA-C)
Entity type:Individual
Prefix:
First Name:BETH
Middle Name:ELISHA
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:420 N 2ND AVE
Mailing Address - Street 2:
Mailing Address - City:SANDPOINT
Mailing Address - State:ID
Mailing Address - Zip Code:83864-1565
Mailing Address - Country:US
Mailing Address - Phone:208-263-0450
Mailing Address - Fax:208-263-0450
Practice Address - Street 1:420 N 2ND AVE
Practice Address - Street 2:
Practice Address - City:SANDPOINT
Practice Address - State:ID
Practice Address - Zip Code:83864-1565
Practice Address - Country:US
Practice Address - Phone:208-263-0450
Practice Address - Fax:208-265-0556
Is Sole Proprietor?:No
Enumeration Date:2014-03-20
Last Update Date:2020-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51505363A00000X
363AM0700X
WAPA60799608363AM0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363AM0700XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantMedical
No363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician Assistant