Provider Demographics
NPI:1720631161
Name:MILLER, LAMEKA Q (FNP)
Entity Type:Individual
Prefix:
First Name:LAMEKA
Middle Name:Q
Last Name:MILLER
Suffix:
Gender:F
Credentials:FNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:110 BRENDALWOOD LN UNIT B
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:MS
Mailing Address - Zip Code:39047-6159
Mailing Address - Country:US
Mailing Address - Phone:769-203-9838
Mailing Address - Fax:
Practice Address - Street 1:919 MISSION 66
Practice Address - Street 2:
Practice Address - City:VICKSBURG
Practice Address - State:MS
Practice Address - Zip Code:39183-2751
Practice Address - Country:US
Practice Address - Phone:601-262-2922
Practice Address - Fax:601-262-2920
Is Sole Proprietor?:No
Enumeration Date:2019-07-23
Last Update Date:2021-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MS903453363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MS04421553Medicaid