MEDICARE: MS. BRENDA R. MILLER FNP

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	363LF0000X	Family Nurse Practitioner	AP03684	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1558342493
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. BRENDA R. MILLER FNP

Provider Business Mailing Address
First Line	:	326 N HOOD ST
Second Line	:
City	:	LAKE PROVIDENCE
State	:	LA
Zip	:	71254-2140
Country	:	US
Telephone Number	:	318-559-4900
Fax Number	:	318-559-1772

Provider Business Practice Location Address
First Line	:	326 N HOOD ST
Second Line	:
City	:	LAKE PROVIDENCE
State	:	LA
Zip	:	71254-2140
Country	:	US
Telephone Number	:	318-559-4900
Fax Number	:	318-559-1772

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/08/2005
Last Update Date	:	10/16/2019

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