Healthcare Provider Details

I. General information

NPI: 1053763813
Provider Name (Legal Business Name): LAKEN MILLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/05/2016
Last Update Date: 10/08/2026
Certification Date: 10/08/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1203 AVENUE B
ELLISVILLE MS
39437-2080
US

IV. Provider business mailing address

PO BOX 247
LAUREL MS
39441-0247
US

V. Phone/Fax

Practice location:
  • Phone: 601-477-8553
  • Fax: 601-477-9158
Mailing address:
  • Phone: 601-399-6169
  • Fax: 601-399-6281

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number901624
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number901624
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: