Healthcare Provider Details

I. General information

NPI: 1235937004
Provider Name (Legal Business Name): CHRISTINA RUTH MILLER NP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 03/06/2025
Last Update Date: 03/07/2025
Certification Date: 03/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

427 HIGHWAY 51 N
BROOKHAVEN MS
39601-2350
US

IV. Provider business mailing address

2081 BALES LN SE
BOGUE CHITTO MS
39629-9750
US

V. Phone/Fax

Practice location:
  • Phone: 601-833-6011
  • Fax:
Mailing address:
  • Phone: 601-519-3288
  • Fax: 601-519-3288

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number907254
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: