MEDICARE: NICHOLE MILLER

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103G00000X	Clinical Neuropsychologist	3521	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1194259036
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICHOLE MILLER

Provider Business Mailing Address
First Line	:	1932 ALCOA HWY STE 150
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-1532
Country	:	US
Telephone Number	:	865-305-2273
Fax Number	:

Provider Business Practice Location Address
First Line	:	1932 ALCOA HWY STE 150
Second Line	:
City	:	KNOXVILLE
State	:	TN
Zip	:	37920-1532
Country	:	US
Telephone Number	:	865-305-2273
Fax Number	:	865-305-7311

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/18/2017
Last Update Date	:	08/29/2019

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Directions to “ NICHOLE MILLER ” Practice Location

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