Healthcare Provider Details

I. General information

NPI: 1184202590
Provider Name (Legal Business Name): MEGAN KAY MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/30/2021
Last Update Date: 08/08/2021
Certification Date: 08/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4727 ROSEBUD LN
NEWBURGH IN
47630-9367
US

IV. Provider business mailing address

7979 ELNA KAY DR
EVANSVILLE IN
47715-6209
US

V. Phone/Fax

Practice location:
  • Phone: 812-429-0772
  • Fax:
Mailing address:
  • Phone: 720-757-2302
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number202104748NP-PP
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number2020146547
License Number StateIN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: