Healthcare Provider Details

I. General information

NPI: 1851900385
Provider Name (Legal Business Name): AMY L. MILLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 04/07/2021
Certification Date: 04/07/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 ODONAVAN BLVD STE 404
WALKER LA
70785-6355
US

IV. Provider business mailing address

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

V. Phone/Fax

Practice location:
  • Phone: 225-369-8100
  • Fax:
Mailing address:
  • Phone: 225-526-0001
  • Fax: 225-765-9196

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number214909
License Number StateLA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: