Provider Demographics
NPI:1932270493
Name:MILLER, JENEICE ANGELA (ARNP)
Entity Type:Individual
Prefix:MS
First Name:JENEICE
Middle Name:ANGELA
Last Name:MILLER
Suffix:
Gender:F
Credentials:ARNP
Other - Prefix:MS
Other - First Name:JENEICE
Other - Middle Name:ANGELA
Other - Last Name:DAVIDSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RN
Mailing Address - Street 1:PO BOX 1330
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73070-1330
Mailing Address - Country:US
Mailing Address - Phone:405-307-6630
Mailing Address - Fax:405-307-6660
Practice Address - Street 1:3440 RC LUTTRELL DR STE 102
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-9007
Practice Address - Country:US
Practice Address - Phone:405-307-2623
Practice Address - Fax:053-075-6194
Is Sole Proprietor?:No
Enumeration Date:2006-11-13
Last Update Date:2023-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0054197363L00000X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKQ75441Medicare UPIN
OK243705805Medicare PIN