Healthcare Provider Details

I. General information

NPI: 1538539374
Provider Name (Legal Business Name): SHEILA DIANE MILLER APRN, FNP-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/06/2015
Last Update Date: 03/07/2023
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1015 S COMMERCE ST
ARDMORE OK
73401-5018
US

IV. Provider business mailing address

1015 S COMMERCE ST
ARDMORE OK
73401-5018
US

V. Phone/Fax

Practice location:
  • Phone: 580-221-5603
  • Fax: 580-221-5648
Mailing address:
  • Phone: 580-221-5603
  • Fax: 580-221-5648

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0600X
TaxonomyGerontology Registered Nurse
License NumberR0086060
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberR0086060
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: