Healthcare Provider Details

I. General information

NPI: 1871877407
Provider Name (Legal Business Name): CASSIE JAMES MILLER PA
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CASSIE SUZANNE JAMES PA

II. Dates (important events)

Enumeration Date: 09/30/2011
Last Update Date: 01/03/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2727 HEARNE AVE SUITE 300
SHREVEPORT LA
71103-3917
US

IV. Provider business mailing address

PO BOX 51008
SHREVEPORT LA
71135-1008
US

V. Phone/Fax

Practice location:
  • Phone: 318-798-9400
  • Fax: 318-798-3894
Mailing address:
  • Phone: 318-798-9400
  • Fax: 318-798-3894

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA.200492
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: