1386069227 NPI number — MRS. JOAN LYNN MILLER APRN

Table of content: MRS. JOAN LYNN MILLER APRN (NPI 1386069227)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386069227 NPI number — MRS. JOAN LYNN MILLER APRN

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
MILLER
Provider First Name:
JOAN
Provider Middle Name:
LYNN
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
APRN
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386069227
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
05/21/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
72 MEDICAL GROUP BUILDING 1094
Provider Second Line Business Mailing Address:
TINKER AIR FORCE BASE
Provider Business Mailing Address City Name:
OKLAHOMA CITY
Provider Business Mailing Address State Name:
OK
Provider Business Mailing Address Postal Code:
73150
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
405-734-2778
Provider Business Mailing Address Fax Number:
405-734-3128

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
TINKER AIR FORCE BASE
Provider Second Line Business Practice Location Address:
72ND MEDICAL GROUP BUILDING 1094, AIR DEPOT BLVD
Provider Business Practice Location Address City Name:
FPO
Provider Business Practice Location Address State Name:
AA
Provider Business Practice Location Address Postal Code:
73150
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
405-734-2778
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/02/2014

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: 363LF0000X , with the licence number:  0065518 , registered in the state of OK ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: F0114303 . This is a "CERTIFICATION" identifier , issued by the state of ( OK ) . This identifiers is of the category "OTHER".




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