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NPI Code Detail

MEDICARE: CANDIECE NICOLE MILLER PA

MEDICARE: CANDIECE NICOLE MILLER PA
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
1363A00000XPhysician Assistant1167OK

General Provider Information

NPI Number : 1639155385
Entity Type Code : Individual
Provider Name (Legal Business Name) : CANDIECE NICOLE MILLER PA
Provider Business Mailing Address
First Line : 1919 E MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73131-1253
Country : US
Telephone Number : 405-749-7099
Fax Number : 405-216-5872
Provider Business Practice Location Address
First Line : 1919 E MEMORIAL RD
Second Line :
City : OKLAHOMA CITY
State : OK
Zip : 73131-1253
Country : US
Telephone Number : 405-749-7099
Fax Number : 405-216-5872
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/15/2005
Last Update Date : 10/22/2020

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Directions to “ CANDIECE NICOLE MILLER PA” Practice Location

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