Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363L00000X | Nurse Practitioner | RN207905 | GA |
N | 363LA2200X | Nurse Practitioner - Adult Health | RN207905 | GA |
N | 363LG0600X | Nurse Practitioner - Gerontology | RN207905 | GA |
NPI | 1033594114 |
---|---|
Provider Name | Mrs. Ashley Miller |
First Address | Newnan, GA 30265-2404 |
Second Address | Newnan, GA 30265-2404 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 30/07/2015 |
Last Update Date | 16/06/2018 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
1033594114 | NURSE PRACTITIONER (01) | GA |
RN207905 | GA BOARD OF NURSING (01) | GA |