Healthcare Provider Details

I. General information

NPI: 1710529888
Provider Name (Legal Business Name): BRITTANY ALAINA CROWELL MILLER AGACNP-BC, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/10/2019
Last Update Date: 03/04/2026
Certification Date: 03/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

208 N 1ST ST
BOONEVILLE MS
38829-2718
US

IV. Provider business mailing address

208 N 1ST ST
BOONEVILLE MS
38829-2718
US

V. Phone/Fax

Practice location:
  • Phone: 662-728-3313
  • Fax: 662-728-5623
Mailing address:
  • Phone: 662-728-3313
  • Fax: 662-728-5623

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number904902
License Number StateMS
# 2
Primary TaxonomyN
Taxonomy Code363LA2100X
TaxonomyAcute Care Nurse Practitioner
License Number904902
License Number StateMS
# 3
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number904902
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: