Provider Demographics
NPI:1720163579
Name:MILLER, CHARMAN LYN MCCAIN (NP)
Entity type:Individual
Prefix:
First Name:CHARMAN
Middle Name:LYN MCCAIN
Last Name:MILLER
Suffix:
Gender:F
Credentials:NP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:341 S PARK AVE
Mailing Address - Street 2:
Mailing Address - City:OAK HILL
Mailing Address - State:OH
Mailing Address - Zip Code:45656-1301
Mailing Address - Country:US
Mailing Address - Phone:740-682-3499
Mailing Address - Fax:
Practice Address - Street 1:8668 STATE ROUTE 93
Practice Address - Street 2:
Practice Address - City:JACKSON
Practice Address - State:OH
Practice Address - Zip Code:45640-9728
Practice Address - Country:US
Practice Address - Phone:740-286-5026
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHNP-07285363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH000000361020OtherBLUE SHIELD
OH2382434Medicaid
OHP00188701OtherRR MEDICARE
OH000000361020OtherBLUE SHIELD
OHMINP12623Medicare ID - Type Unspecified