MEDICARE: JACQUELYN MILLER PA - C

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	363AM0700X	Medical Physician Assistant	PA00284	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	PA00284	OTHER	TX	PHYSICIAN ASSISTANT PERMI

General Provider Information

NPI Number	:	1649249665
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	JACQUELYN MILLER PA - C

Provider Business Mailing Address
First Line	:	1105 CENTRAL EXPY N
Second Line	:	SUITE 120
City	:	ALLEN
State	:	TX
Zip	:	75013-6103
Country	:	US
Telephone Number	:	972-727-9995
Fax Number	:	972-727-8350

Provider Business Practice Location Address
First Line	:	11970 N CENTRAL EXPY
Second Line	:
City	:	DALLAS
State	:	TX
Zip	:	75243-3768
Country	:	US
Telephone Number	:	972-940-8000
Fax Number	:

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

Provider Enumeration Date	:	03/14/2006
Last Update Date	:	01/04/2022

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