Provider Demographics
NPI:1366927584
Name:MILLER, JODY JAE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:JODY
Middle Name:JAE
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:89 W 2875 NORTH CIR
Mailing Address - Street 2:
Mailing Address - City:CEDAR CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84721-5958
Mailing Address - Country:US
Mailing Address - Phone:435-531-1637
Mailing Address - Fax:
Practice Address - Street 1:1251 NORTHFIELD RD STE 301
Practice Address - Street 2:
Practice Address - City:CEDAR CITY
Practice Address - State:UT
Practice Address - Zip Code:84721-8625
Practice Address - Country:US
Practice Address - Phone:435-865-7227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-10-03
Last Update Date:2024-02-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT359204-8900363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily