Healthcare Provider Details

I. General information

NPI: 1720932163
Provider Name (Legal Business Name): MICHELLE ANGELA MILLER FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/23/2026
Last Update Date: 02/23/2026
Certification Date: 02/23/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3860 S LINDBERGH BLVD STE 108
SAINT LOUIS MO
63127-1373
US

IV. Provider business mailing address

19 EAGLE LAKE DR
COLUMBIA IL
62236-4448
US

V. Phone/Fax

Practice location:
  • Phone: 314-255-4891
  • Fax:
Mailing address:
  • Phone: 314-255-4891
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2026008547
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: