Provider Demographics
NPI:1508187048
Name:MILLER, CARMEN LOUISE (ACNS-BC)
Entity Type:Individual
Prefix:
First Name:CARMEN
Middle Name:LOUISE
Last Name:MILLER
Suffix:
Gender:F
Credentials:ACNS-BC
Other - Prefix:
Other - First Name:CARMEN
Other - Middle Name:LOUISE
Other - Last Name:DRINKWATER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1915 WHITE AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37916-2300
Mailing Address - Country:US
Mailing Address - Phone:865-541-1720
Mailing Address - Fax:865-541-4994
Practice Address - Street 1:576 FORT LOUDOUN MEDICAL CENTER DR STE 207
Practice Address - Street 2:
Practice Address - City:LENOIR CITY
Practice Address - State:TN
Practice Address - Zip Code:37772-5676
Practice Address - Country:US
Practice Address - Phone:865-271-6095
Practice Address - Fax:865-271-6096
Is Sole Proprietor?:Yes
Enumeration Date:2010-06-18
Last Update Date:2010-06-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN15023364SA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health