Healthcare Provider Details

I. General information

NPI: 1629532122
Provider Name (Legal Business Name): SHARONDA RENEE MILLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/29/2019
Last Update Date: 03/04/2025
Certification Date: 03/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

116 S MAIN ST
NASHVILLE AR
71852-2406
US

IV. Provider business mailing address

116 S MAIN ST
NASHVILLE AR
71852-2406
US

V. Phone/Fax

Practice location:
  • Phone: 870-455-0256
  • Fax:
Mailing address:
  • Phone: 870-455-0256
  • Fax: 870-455-8958

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA006086
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: