Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 207R00000X | Internist | 1063936540 | TX |
N | 111NI0900X | Internist | 1063936540 | TX |
Y | 363LG0600X | Nurse Practitioner - Gerontology | AP134511 | TX |
NPI | 1063936540 |
---|---|
Provider Name | Amy L Miller |
First Address | Plano, TX 75075-3397 |
Second Address | Dallas, TX 75246 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 27/07/2017 |
Last Update Date | 09/07/2018 |