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General NPI Number Information
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NPI Number | 1720843725
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Entity Type | Organization
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Legal Business Name | MISSY AND CLARK MILLER LLC
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Dates
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Enumeration Date | 02/19/2024
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Last Update Date | 02/19/2024
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Provider Practice Location Address
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Address Line | 11128 SHEFFIELD DR
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City | ANNA
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State | TX
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Zip | 75409-7670
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Country | US
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Telephone | 214-578-9168
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Fax |
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Provider Business Mailing Address
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Address Line | 11128 SHEFFIELD DR
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City | ANNA
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State | TX
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Zip | 75409-7670
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Country | US
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Telephone | 214-578-9168
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MELISSA MILLER
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Credential | RD/LD
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Telephone | 214-578-9168
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 133NN1002X
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Taxonomy Name | Nutrition Education Nutritionist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 133V00000X
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Taxonomy Name | Registered Dietitian
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License Number |
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License Number State |
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