1952397234 NPI number — MRS. JANE JERNIGAN MILLER APRN BC FNP

Table of content: MRS. KIMBERLY ELLINGSON KOTUR APRN-BC FNP (NPI 1114093077)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1952397234 NPI number — MRS. JANE JERNIGAN MILLER APRN BC FNP

Organization/Personal Information

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

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
COURTNEY
Provider Other First Name:
MARTHA
Provider Other Middle Name:
JANE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1952397234
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
08/16/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
07/17/2007
NPI Reactivation Date:
07/20/2007

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
321 PLEASANT PL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CHARLOTTESVILLE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22911-2212
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
434-975-9912
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1215 LEE ST
Provider Second Line Business Practice Location Address:
UNIVERSITY OF VIRGINIA HEALTH SYSTEM
Provider Business Practice Location Address City Name:
CHARLOTTESVILLE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22908-0816
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
434-243-4849
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/22/2005

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: 133V00000X , with the licence number:  605919 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 174400000X , with the licence number: 0971-0209 , registered in the state of GA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: 0024164858 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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