Provider Demographics
NPI:1366473100
Name:MILLER, GINA L (NP)
Entity type:Individual
Prefix:MS
First Name:GINA
Middle Name:L
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 MAIN ST
Mailing Address - Street 2:
Mailing Address - City:HACKBERRY
Mailing Address - State:LA
Mailing Address - Zip Code:70645-3303
Mailing Address - Country:US
Mailing Address - Phone:337-788-1081
Mailing Address - Fax:337-788-1083
Practice Address - Street 1:1020 MAIN ST
Practice Address - Street 2:
Practice Address - City:HACKBERRY
Practice Address - State:LA
Practice Address - Zip Code:70645-3303
Practice Address - Country:US
Practice Address - Phone:337-788-1081
Practice Address - Fax:337-788-1083
Is Sole Proprietor?:No
Enumeration Date:2006-07-06
Last Update Date:2017-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAAP04570363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1780944Medicaid
LAQ72912Medicare UPIN
LA4H964CV63Medicare PIN