Basic Information
| Provider Information | |||||||||
| NPI: | 1649250531 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | MILLER | ||||||||
| FirstName: | ELISSA | ||||||||
| MiddleName: | L | ||||||||
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| Credential: | NP | ||||||||
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| Mailing Information | |||||||||
| Address1: | 610 SHEPHERD WAY DR | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721437433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012686831 | ||||||||
| FaxNumber: | 5012792402 | ||||||||
| Practice Location | |||||||||
| Address1: | 610 SHEPHERD DR | ||||||||
| Address2: | |||||||||
| City: | SEARCY | ||||||||
| State: | AR | ||||||||
| PostalCode: | 721437433 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5012686831 | ||||||||
| FaxNumber: | 5012792402 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/18/2006 | ||||||||
| LastUpdateDate: | 02/24/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 363LF0000X | A03103ANP | AR | Y | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Family | 367A00000X | 4497M | KY | N | Physician Assistants & Advanced Practice Nursing Providers | Advanced Practice Midwife |
No ID Information.