Healthcare Provider Details

I. General information

NPI: 1619423472
Provider Name (Legal Business Name): FAITH MELINDA MILLER PMHNP-BC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: FAITH MELINDA PANGBURN RN

II. Dates (important events)

Enumeration Date: 08/31/2016
Last Update Date: 10/26/2023
Certification Date: 02/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2526 E 71ST ST STE J
TULSA OK
74136-5576
US

IV. Provider business mailing address

2526 E 71ST ST STE J
TULSA OK
74136-5576
US

V. Phone/Fax

Practice location:
  • Phone: 918-268-9578
  • Fax: 918-471-2854
Mailing address:
  • Phone: 918-268-9578
  • Fax: 918-471-2854

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WG0000X
TaxonomyGeneral Practice Registered Nurse
License Number105704
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number105704
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: