Healthcare Provider Details

I. General information

NPI: 1205793650
Provider Name (Legal Business Name): MAGGIE MILLER AGNP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/07/2026
Last Update Date: 01/07/2026
Certification Date: 01/06/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12266 DEPAUL DRIVE SUITE 205
BRIDGETON MO
63044
US

IV. Provider business mailing address

12266 DEPAUL DRIVE SUITE 205
BRIDGETON MO
63044
US

V. Phone/Fax

Practice location:
  • Phone: 314-218-2300
  • Fax:
Mailing address:
  • Phone: 314-218-2300
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: