Healthcare Provider Details

I. General information

NPI: 1578025441
Provider Name (Legal Business Name): JALEESA ANTOINETTE MILLER ARNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/01/2019
Last Update Date: 02/02/2022
Certification Date: 01/27/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1600 7TH AVE S
BIRMINGHAM AL
35233-1711
US

IV. Provider business mailing address

2709 17TH AVE S # 618
SEATTLE WA
98144-5249
US

V. Phone/Fax

Practice location:
  • Phone: 205-638-9100
  • Fax:
Mailing address:
  • Phone: 251-550-8511
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License Number1-166348
License Number StateAL
# 2
Primary TaxonomyY
Taxonomy Code363LP0200X
TaxonomyPediatric Nurse Practitioner
License Number61226976
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: