Healthcare Provider Details

I. General information

NPI: 1437912557
Provider Name (Legal Business Name): JESSICA NICHOLE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/01/2024
Last Update Date: 09/08/2026
Certification Date: 09/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15210 N SCOTTSDALE RD STE 275
SCOTTSDALE AZ
85254-8128
US

IV. Provider business mailing address

15210 N SCOTTSDALE RD STE 275
SCOTTSDALE AZ
85254-8128
US

V. Phone/Fax

Practice location:
  • Phone: 888-663-6331
  • Fax: 415-252-7176
Mailing address:
  • Phone: 888-663-6331
  • Fax: 415-252-7176

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number13777837-1206
License Number StateUT
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License Number11801
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: