Provider Demographics
NPI:1194538074
Name:MILLER, AMANDA REA (RN, MSN, PMHNP-BC)
Entity type:Individual
Prefix:
First Name:AMANDA
Middle Name:REA
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN, MSN, PMHNP-BC
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Mailing Address - Street 1:6805 IL 162
Mailing Address - Street 2:SUITE 201
Mailing Address - City:MARYVILLE
Mailing Address - State:IL
Mailing Address - Zip Code:62062
Mailing Address - Country:US
Mailing Address - Phone:618-288-5019
Mailing Address - Fax:618-288-5059
Practice Address - Street 1:6805 IL 162
Practice Address - Street 2:SUITE 201
Practice Address - City:MARYVILLE
Practice Address - State:IL
Practice Address - Zip Code:62062
Practice Address - Country:US
Practice Address - Phone:618-288-5019
Practice Address - Fax:618-288-5059
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-27
Last Update Date:2025-10-27
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MO2025002297363LP0808X
MO2021007992163WP0808X
IL209032950363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No163WP0808XNursing Service ProvidersRegistered NursePsychiatric/Mental Health