Healthcare Provider Details

I. General information

NPI: 1215685656
Provider Name (Legal Business Name): CHALYN RAINE MILLER CRNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/15/2022
Last Update Date: 03/15/2022
Certification Date: 03/15/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1924K DAUPHIN ISLAND PKWY
MOBILE AL
36605-3004
US

IV. Provider business mailing address

411 DYKES RD S
MOBILE AL
36608-8437
US

V. Phone/Fax

Practice location:
  • Phone: 251-308-9800
  • Fax: 877-413-5104
Mailing address:
  • Phone: 251-214-2572
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LA2200X
TaxonomyAdult Health Nurse Practitioner
License Number1-152058
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: