=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619423472
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | FAITH MELINDA MILLER PMHNP-BC
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/31/2016
-----------------------------------------------------
Last Update Date | 10/26/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 2526 E 71ST ST STE J
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74136-5576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-268-9578
-----------------------------------------------------
Fax | 918-471-2854
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2526 E 71ST ST STE J
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74136-5576
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-268-9578
-----------------------------------------------------
Fax | 918-471-2854
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WG0000X
-----------------------------------------------------
Taxonomy Name | General Practice Registered Nurse
-----------------------------------------------------
License Number | 105704
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 363LP0808X
-----------------------------------------------------
Taxonomy Name | Psychiatric/Mental Health Nurse Practitioner
-----------------------------------------------------
License Number | 105704
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------