Healthcare Provider Details

I. General information

NPI: 1629011846
Provider Name (Legal Business Name): JAMES O MILLER FNP
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/14/2006
Last Update Date: 06/21/2022
Certification Date: 06/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11125 DUNN RD STE 406
SAINT LOUIS MO
63136-6132
US

IV. Provider business mailing address

11125 DUNN RD STE 406
SAINT LOUIS MO
63136-6132
US

V. Phone/Fax

Practice location:
  • Phone: 314-653-5484
  • Fax:
Mailing address:
  • Phone: 314-653-5484
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number155854
License Number StateMO
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number209004407
License Number StateIL
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number155854
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: