Provider Demographics
NPI:1063936540
Name:MILLER, AMY L (AGNP)
Entity type:Individual
Prefix:
First Name:AMY
Middle Name:L
Last Name:MILLER
Suffix:
Gender:
Credentials:AGNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3200 DOVER DR
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75075-3397
Mailing Address - Country:US
Mailing Address - Phone:214-620-5424
Mailing Address - Fax:
Practice Address - Street 1:2441 GLEN COVE DR
Practice Address - Street 2:
Practice Address - City:WOODLAND PARK
Practice Address - State:CO
Practice Address - Zip Code:80863-7001
Practice Address - Country:US
Practice Address - Phone:214-620-5424
Practice Address - Fax:855-715-9478
Is Sole Proprietor?:No
Enumeration Date:2017-07-27
Last Update Date:2025-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP134511364SA2200X, 363LG0600X
TX1063936540207R00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LG0600XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGerontology
No364SA2200XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistAdult Health
No207R00000XAllopathic & Osteopathic PhysiciansInternal Medicine