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General NPI Number Information
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NPI Number | 1649249665
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Entity Type | Individual
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Provider Name | JACQUELYN MILLER PA - C
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Gender | Female
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Dates
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Enumeration Date | 03/14/2006
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Last Update Date | 01/04/2022
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Provider Practice Location Address
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Address Line | 11970 N CENTRAL EXPY
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City | DALLAS
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State | TX
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Zip | 75243-3768
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Country | US
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Telephone | 972-940-8000
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Fax |
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Provider Business Mailing Address
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Address Line | 1105 CENTRAL EXPY N SUITE 120
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City | ALLEN
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State | TX
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Zip | 75013-6103
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Country | US
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Telephone | 972-727-9995
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Fax | 972-727-8350
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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 | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | PA00284
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License Number State | TX
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