Provider Demographics
NPI:1174125991
Name:MILLER, JESSICA EMMA (CRNP)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:EMMA
Last Name:MILLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19305 UPPER CONSOL RD NW
Mailing Address - Street 2:
Mailing Address - City:FROSTBURG
Mailing Address - State:MD
Mailing Address - Zip Code:21532-2185
Mailing Address - Country:US
Mailing Address - Phone:717-375-8931
Mailing Address - Fax:
Practice Address - Street 1:925 BISHOP WALSH RD
Practice Address - Street 2:
Practice Address - City:CUMBERLAND
Practice Address - State:MD
Practice Address - Zip Code:21502-1845
Practice Address - Country:US
Practice Address - Phone:240-362-7025
Practice Address - Fax:240-362-7064
Is Sole Proprietor?:No
Enumeration Date:2020-11-16
Last Update Date:2020-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR196698363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1417460619OtherTYPE 2 NPI GROUP
MD1669037008OtherTYPE 2 NPI GROUP
MD392004600Medicaid