Provider Demographics
NPI:1154106177
Name:MILLER, WYNTER HAVEN (AGACNP)
Entity type:Individual
Prefix:
First Name:WYNTER
Middle Name:HAVEN
Last Name:MILLER
Suffix:
Gender:F
Credentials:AGACNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:80 MARYLAND DR
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:TN
Mailing Address - Zip Code:38301-3334
Mailing Address - Country:US
Mailing Address - Phone:731-439-7673
Mailing Address - Fax:
Practice Address - Street 1:80 MARYLAND DR
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:TN
Practice Address - Zip Code:38301-3334
Practice Address - Country:US
Practice Address - Phone:731-439-7673
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN34418363LA2100X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LA2100XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAcute Care