Healthcare Provider Details

I. General information

NPI: 1649250531
Provider Name (Legal Business Name): ELISSA L MILLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/18/2006
Last Update Date: 02/24/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

610 SHEPHERD DR
SEARCY AR
72143-7433
US

IV. Provider business mailing address

610 SHEPHERD WAY DR
SEARCY AR
72143-7433
US

V. Phone/Fax

Practice location:
  • Phone: 501-268-6831
  • Fax: 501-279-2402
Mailing address:
  • Phone: 501-268-6831
  • Fax: 501-279-2402

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberA03103ANP
License Number StateAR
# 2
Primary TaxonomyN
Taxonomy Code367A00000X
TaxonomyAdvanced Practice Midwife
License Number4497M
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: