Healthcare Provider Details

I. General information

NPI: 1366360281
Provider Name (Legal Business Name): RIVERS MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

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

III. Provider practice location address

110 E BAKER ST STE B
INDIANOLA MS
38751-2451
US

IV. Provider business mailing address

121 E BAKER ST
INDIANOLA MS
38751-2498
US

V. Phone/Fax

Practice location:
  • Phone: 662-887-5530
  • Fax:
Mailing address:
  • Phone: 662-207-6059
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number908564
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: