Healthcare Provider Details

I. General information

NPI: 1124804489
Provider Name (Legal Business Name): STEPHANIE MILLER FNP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/04/2023
Last Update Date: 09/04/2023
Certification Date: 09/02/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

235 SINGLETON RIDGE RD
CONWAY SC
29526-9136
US

IV. Provider business mailing address

2206 HAYSTACK WAY
MYRTLE BEACH SC
29579-3279
US

V. Phone/Fax

Practice location:
  • Phone: 843-347-2121
  • Fax:
Mailing address:
  • Phone: 843-999-5661
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number27815
License Number StateSC

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: