Provider Demographics
NPI:1649250531
Name:MILLER, ELISSA L (NP)
Entity type:Individual
Prefix:
First Name:ELISSA
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:610 SHEPHERD WAY DR
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7433
Mailing Address - Country:US
Mailing Address - Phone:501-268-6831
Mailing Address - Fax:501-279-2402
Practice Address - Street 1:610 SHEPHERD DR
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-7433
Practice Address - Country:US
Practice Address - Phone:501-268-6831
Practice Address - Fax:501-279-2402
Is Sole Proprietor?:No
Enumeration Date:2006-01-18
Last Update Date:2012-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA03103ANP363LF0000X
KY4497M367A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No367A00000XPhysician Assistants & Advanced Practice Nursing ProvidersAdvanced Practice Midwife
Provider Identifiers
StateIdentifier IDID TypeIssuer
S61959Medicare UPIN