Healthcare Provider Details

I. General information

NPI: 1508409350
Provider Name (Legal Business Name): SHEENA TIANA MILLER APRN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/24/2019
Last Update Date: 06/30/2026
Certification Date: 06/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6625 LENOX PARK DR STE 101
MEMPHIS TN
38115-4397
US

IV. Provider business mailing address

6625 LENOX PARK DR STE 202
MEMPHIS TN
38115-8200
US

V. Phone/Fax

Practice location:
  • Phone: 901-683-0024
  • Fax: 901-683-0086
Mailing address:
  • Phone: 901-683-0024
  • Fax: 901-683-0086

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License NumberAP143699
License Number StateTX
# 2
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number872867
License Number StateTX
# 3
Primary TaxonomyN
Taxonomy Code363LF0000X
TaxonomyFamily Nurse Practitioner
License Number40979
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: