Healthcare Provider Details

I. General information

NPI: 1356607469
Provider Name (Legal Business Name): DR. NICHOLE THERESE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/03/2012
Last Update Date: 09/09/2025
Certification Date: 09/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2932 AMBASSADOR CAFFERY PKWY STE B
LAFAYETTE LA
70506-6756
US

IV. Provider business mailing address

5959 S SHERWOOD FOREST BLVD
BATON ROUGE LA
70816-6038
US

V. Phone/Fax

Practice location:
  • Phone: 337-470-3080
  • Fax: 337-470-3099
Mailing address:
  • Phone: 337-470-3080
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License NumberMD.207219
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: