Provider Demographics
NPI:1023306321
Name:MILLER, JESSICA DAUN (PA)
Entity type:Individual
Prefix:MRS
First Name:JESSICA
Middle Name:DAUN
Last Name:MILLER
Suffix:
Gender:F
Credentials:PA
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Other - First Name:
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Mailing Address - Street 1:8618 PALOMAR AVE
Mailing Address - Street 2:
Mailing Address - City:YUCCA VALLEY
Mailing Address - State:CA
Mailing Address - Zip Code:92284-6358
Mailing Address - Country:US
Mailing Address - Phone:760-416-3770
Mailing Address - Fax:760-320-8551
Practice Address - Street 1:1180 N INDIAN CANYON DR STE W300
Practice Address - Street 2:
Practice Address - City:PALM SPRINGS
Practice Address - State:CA
Practice Address - Zip Code:92262-4809
Practice Address - Country:US
Practice Address - Phone:760-416-3770
Practice Address - Fax:760-320-8551
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-20
Last Update Date:2011-07-20
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
CAPA21506363A00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363A00000XPhysician Assistants & Advanced Practice Nursing ProvidersPhysician AssistantGroup - Single Specialty