MEDICARE: MRS. JOAN LYNN MILLER APRN

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	363LF0000X	Family Nurse Practitioner	0065518	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	F0114303	OTHER	OK	CERTIFICATION

General Provider Information

NPI Number	:	1386069227
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. JOAN LYNN MILLER APRN

Provider Business Mailing Address
First Line	:	72 MEDICAL GROUP BUILDING 1094
Second Line	:	TINKER AIR FORCE BASE
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73150
Country	:	US
Telephone Number	:	405-734-2778
Fax Number	:	405-734-3128

Provider Business Practice Location Address
First Line	:	TINKER AIR FORCE BASE
Second Line	:	72ND MEDICAL GROUP BUILDING 1094, AIR DEPOT BLVD
City	:	FPO
State	:	AA
Zip	:	73150
Country	:	US
Telephone Number	:	405-734-2778
Fax Number	:

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

Provider Enumeration Date	:	03/02/2014
Last Update Date	:	05/21/2020

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