Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 363LA2100X | Nurse Practitioner - Acute Care | 1033454 | TX |
N | 363LA2200X | Nurse Practitioner - Adult Health | 1033454 | TX |
N | 363LG0600X | Nurse Practitioner - Gerontology | 1033454 | TX |
NPI | 1013687961 |
---|---|
Provider Name | Ms. Courtney Miller |
First Address | Mansfield, TX 76063-4035 |
Second Address | Mansfield, TX 76063-4035 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/09/2021 |
Last Update Date | 13/09/2021 |