=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073124764
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | JANAE MILLER APRN-CNP
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/14/2020
-----------------------------------------------------
Last Update Date | 02/28/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 3151 E RIVER RD
-----------------------------------------------------
City | NEWKIRK
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74647-7517
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-362-1039
-----------------------------------------------------
Fax | 580-362-1467
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3151 EAST RIVER ROAD PO BOX 474
-----------------------------------------------------
City | NEWKIRK
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74647-0474
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 580-362-1039
-----------------------------------------------------
Fax | 580-362-1467
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number | R0123092
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------