Provider Demographics
NPI:1316423510
Name:MILLER, KRYSTINE DOROTHY (APRN)
Entity type:Individual
Prefix:
First Name:KRYSTINE
Middle Name:DOROTHY
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:400 S MAIN ST STE 100
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72143-7801
Mailing Address - Country:US
Mailing Address - Phone:501-279-9000
Mailing Address - Fax:501-279-9011
Practice Address - Street 1:812 OAK ST
Practice Address - Street 2:
Practice Address - City:CONWAY
Practice Address - State:AR
Practice Address - Zip Code:72032-4408
Practice Address - Country:US
Practice Address - Phone:501-279-9000
Practice Address - Fax:501-279-9011
Is Sole Proprietor?:No
Enumeration Date:2018-07-11
Last Update Date:2022-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA005771363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily