MEDICARE: AMY 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	207Q00000X	Family Medicine Physician	AP08866	LA

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	AP08866	OTHER	LA	MEDICAL LICENSE

General Provider Information

NPI Number	:	1568814168
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	AMY MILLER

Provider Business Mailing Address
First Line	:	3057 HIGHWAY 80 W
Second Line	:
City	:	CALHOUN
State	:	LA
Zip	:	71225-7907
Country	:	US
Telephone Number	:	318-644-5838
Fax Number	:

Provider Business Practice Location Address
First Line	:	3057 HIGHWAY 80 W
Second Line	:
City	:	CALHOUN
State	:	LA
Zip	:	71225-7907
Country	:	US
Telephone Number	:	318-644-5838
Fax Number	:

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

Provider Enumeration Date	:	07/07/2016
Last Update Date	:	07/11/2016

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Directions to “ AMY MILLER ” Practice Location

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