Provider Demographics
NPI:1386069227
Name:MILLER, JOAN LYNN (APRN)
Entity type:Individual
Prefix:MRS
First Name:JOAN
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:72 MEDICAL GROUP BUILDING 1094
Mailing Address - Street 2:TINKER AIR FORCE BASE
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73150
Mailing Address - Country:US
Mailing Address - Phone:405-734-2778
Mailing Address - Fax:405-734-3128
Practice Address - Street 1:TINKER AIR FORCE BASE
Practice Address - Street 2:72ND MEDICAL GROUP BUILDING 1094, AIR DEPOT BLVD
Practice Address - City:FPO
Practice Address - State:AA
Practice Address - Zip Code:73150
Practice Address - Country:US
Practice Address - Phone:405-734-2778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-02
Last Update Date:2020-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0065518363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKF0114303OtherCERTIFICATION