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General NPI Number Information
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NPI Number | 1740170935
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Entity Type | Individual
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Provider Name | JACQUELYN BURGE MILLER FNP
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Gender | Female
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Dates
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Enumeration Date | 07/08/2025
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Last Update Date | 11/20/2025
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Provider Practice Location Address
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Address Line | 2449 HOSPITAL DR STE 340
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City | BOSSIER CITY
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State | LA
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Zip | 71111-1912
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Country | US
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Telephone | 318-212-7160
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Fax | 318-212-7164
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Provider Business Mailing Address
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Address Line | 940 COTTON VALLEY RD
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City | HAUGHTON
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State | LA
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Zip | 71037-7312
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Country | US
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Telephone | 318-469-1375
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Fax |
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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 | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | 211799
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License Number State | LA
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