Provider Demographics
NPI:1487075545
Name:MILLER, JESSICA ANN (APRN)
Entity type:Individual
Prefix:
First Name:JESSICA
Middle Name:ANN
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 1:5420 WEST LOOP S
Mailing Address - Street 2:SUITE 2400
Mailing Address - City:BELLAIRE
Mailing Address - State:TX
Mailing Address - Zip Code:77401-2107
Mailing Address - Country:US
Mailing Address - Phone:713-486-3507
Mailing Address - Fax:713-314-2990
Practice Address - Street 1:5420 WEST LOOP S
Practice Address - Street 2:SUITE 2400
Practice Address - City:BELLAIRE
Practice Address - State:TX
Practice Address - Zip Code:77401-2107
Practice Address - Country:US
Practice Address - Phone:713-486-3507
Practice Address - Fax:713-314-2990
Is Sole Proprietor?:No
Enumeration Date:2013-12-16
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL209.011107363LF0000X
TXAP131893363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF400146890Medicare PIN
ILPENDINGMedicaid