Provider Demographics
NPI:1215685656
Name:MILLER, CHALYN RAINE (CRNP)
Entity type:Individual
Prefix:
First Name:CHALYN
Middle Name:RAINE
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 1:411 DYKES RD S
Mailing Address - Street 2:
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-8437
Mailing Address - Country:US
Mailing Address - Phone:251-214-2572
Mailing Address - Fax:
Practice Address - Street 1:1924K DAUPHIN ISLAND PKWY
Practice Address - Street 2:
Practice Address - City:MOBILE
Practice Address - State:AL
Practice Address - Zip Code:36605-3004
Practice Address - Country:US
Practice Address - Phone:251-308-9800
Practice Address - Fax:877-413-5104
Is Sole Proprietor?:Yes
Enumeration Date:2022-03-15
Last Update Date:2022-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL1-152058363LA2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LA2200XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerAdult HealthGroup - Single Specialty