1376603019 NPI number — ANGELA RAE MILLER MSN, RN, CPNP-PC

Table of content: BRITTANY JOSEPH (NPI 1588373724)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376603019 NPI number — ANGELA RAE MILLER MSN, RN, CPNP-PC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
ANGELA
Provider Middle Name:
RAE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSN, RN, CPNP-PC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
ROYAL
Provider Other First Name:
ANGIE
Provider Other Middle Name:
RAE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
BSN, RN
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1376603019
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/26/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 733784
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DALLAS
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
75373-3784
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
682-885-1855
Provider Business Mailing Address Fax Number:
682-885-1396

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1500 COOPER ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FORT WORTH
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
76104-2710
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
682-885-1485
Provider Business Practice Location Address Fax Number:
817-338-1841
Provider Enumeration Date:
12/11/2006

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 363LP0200X , with the licence number:  621625 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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