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General NPI Number Information
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NPI Number | 1194538074
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Entity Type | Individual
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Provider Name | AMANDA REA MILLER RN, MSN, PMHNP-BC
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Gender | Female
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Dates
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Enumeration Date | 01/27/2025
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Last Update Date | 10/27/2025
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Provider Practice Location Address
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Address Line | 6805 IL 162 SUITE 201
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City | MARYVILLE
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State | IL
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Zip | 62062
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Country | US
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Telephone | 618-288-5019
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Fax | 618-288-5059
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Provider Business Mailing Address
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Address Line | 6805 IL 162 SUITE 201
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City | MARYVILLE
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State | IL
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Zip | 62062
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Country | US
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Telephone | 618-288-5019
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Fax | 618-288-5059
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 2025002297
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License Number State | MO
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Taxonomy #2
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Taxonomy Code | 163WP0808X
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Taxonomy Name | Psychiatric/Mental Health Registered Nurse
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License Number | 2021007992
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License Number State | MO
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Taxonomy #3
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Taxonomy Code | 363LP0808X
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Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
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License Number | 209032950
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License Number State | IL
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