Healthcare Provider Details

I. General information

NPI: 1902937121
Provider Name (Legal Business Name): MISTY LYNN MILLER BSW, QMRP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MISTY LYNN MILLER BSW, QMRP

II. Dates (important events)

Enumeration Date: 03/08/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

607 N RIDGEVIEW DR
WARRENSBURG MO
64093-9338
US

IV. Provider business mailing address

607 N RIDGEVIEW DR
WARRENSBURG MO
64093-9338
US

V. Phone/Fax

Practice location:
  • Phone: 660-747-7990
  • Fax: 660-747-7997
Mailing address:
  • Phone: 660-747-7990
  • Fax: 660-747-7997

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: