Healthcare Provider Details

I. General information

NPI: 1073801734
Provider Name (Legal Business Name): MICHELLE K MILLER F.N.P.-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MICHELLE K CRAIN FNP

II. Dates (important events)

Enumeration Date: 07/15/2011
Last Update Date: 09/30/2021
Certification Date: 09/30/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

777 S MAIN ST STE 100
CLINTON IN
47842-2493
US

IV. Provider business mailing address

250 N SHADELAND AVE SUITE 130 - PROVIDER ENROLLMENT
INDIANAPOLIS IN
46219-4959
US

V. Phone/Fax

Practice location:
  • Phone: 765-828-1003
  • Fax:
Mailing address:
  • Phone: 800-732-1066
  • Fax: 317-962-4343

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number28179417A
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209018042
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number71003631A
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: