Provider Demographics
NPI:1801166988
Name:MILLER, JACQUELYN PERRY (RN)
Entity type:Individual
Prefix:
First Name:JACQUELYN
Middle Name:PERRY
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:13504 TAYLOR DRIVE
Mailing Address - Street 2:
Mailing Address - City:DISPUTANTA
Mailing Address - State:VA
Mailing Address - Zip Code:23842
Mailing Address - Country:US
Mailing Address - Phone:804-514-1007
Mailing Address - Fax:
Practice Address - Street 1:26317 WEST WASHINGTON STREET
Practice Address - Street 2:BUILDING 66
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23842
Practice Address - Country:US
Practice Address - Phone:804-722-4299
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-06
Last Update Date:2012-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA0001186020163W00000X, 163WP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health
No163W00000XNursing Service ProvidersRegistered Nurse