Provider Demographics
NPI:1386898302
Name:MILLER, JACKLYN JEAN (BSN, RN)
Entity type:Individual
Prefix:
First Name:JACKLYN
Middle Name:JEAN
Last Name:MILLER
Suffix:
Gender:F
Credentials:BSN, RN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:E HWY 18
Mailing Address - Street 2:INDIAN HEALTH SERVICE HOSPITAL
Mailing Address - City:PINE RIDGE
Mailing Address - State:SD
Mailing Address - Zip Code:57770
Mailing Address - Country:US
Mailing Address - Phone:605-867-3010
Mailing Address - Fax:
Practice Address - Street 1:E HWY 18
Practice Address - Street 2:PINE RIDGE INDIAN HEALTH SERVICES
Practice Address - City:PINE RIDGE
Practice Address - State:SD
Practice Address - Zip Code:57770
Practice Address - Country:US
Practice Address - Phone:605-867-3010
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-11-05
Last Update Date:2008-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDR32348163W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes163W00000XNursing Service ProvidersRegistered Nurse