Healthcare Provider Details

I. General information

NPI: 1700648052
Provider Name (Legal Business Name): MOLLY MILLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: MOLLY PRICE

II. Dates (important events)

Enumeration Date: 01/23/2024
Last Update Date: 04/22/2026
Certification Date: 04/22/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14410 ROUTE 37
JOHNSTON CITY IL
62951-3166
US

IV. Provider business mailing address

PO BOX 155
CHRISTOPHER IL
62822-0155
US

V. Phone/Fax

Practice location:
  • Phone: 618-983-6911
  • Fax: 618-983-2815
Mailing address:
  • Phone: 618-724-2401
  • Fax: 618-724-4628

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number209029018
License Number StateIL
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209.029018
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: