Healthcare Provider Details

I. General information

NPI: 1295476596
Provider Name (Legal Business Name): JAPRI NICOLE MILLER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 04/02/2022
Last Update Date: 03/11/2026
Certification Date: 03/11/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1920 W 1ST ST
WINSTON SALEM NC
27104-4220
US

IV. Provider business mailing address

1930 N PEACE HAVEN RD
WINSTON SALEM NC
27106-4817
US

V. Phone/Fax

Practice location:
  • Phone: 336-716-4479
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number2025-02559
License Number StateNC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: