MEDICARE: SHARONDA RENEE MILLER FNP

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	A006086	AR

General Provider Information

NPI Number	:	1629532122
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARONDA RENEE MILLER FNP

Provider Business Mailing Address
First Line	:	116 S MAIN ST
Second Line	:
City	:	NASHVILLE
State	:	AR
Zip	:	71852-2406
Country	:	US
Telephone Number	:	870-455-0256
Fax Number	:	870-455-8958

Provider Business Practice Location Address
First Line	:	116 S MAIN ST
Second Line	:
City	:	NASHVILLE
State	:	AR
Zip	:	71852-2406
Country	:	US
Telephone Number	:	870-455-0256
Fax Number	:

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

Provider Enumeration Date	:	01/29/2019
Last Update Date	:	03/04/2025

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