Provider Demographics
NPI:1982104881
Name:MILLER, CHRISTY LYNN (CRNP)
Entity type:Individual
Prefix:
First Name:CHRISTY
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:CRNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:312-T SCHILLINGER RD S
Mailing Address - Street 2:PMB# 147
Mailing Address - City:MOBILE
Mailing Address - State:AL
Mailing Address - Zip Code:36608-3486
Mailing Address - Country:US
Mailing Address - Phone:251-599-8799
Mailing Address - Fax:
Practice Address - Street 1:3300 SHENANDOAH TRAIL
Practice Address - Street 2:
Practice Address - City:SEMMES
Practice Address - State:AL
Practice Address - Zip Code:36575
Practice Address - Country:US
Practice Address - Phone:251-471-2350
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-02-16
Last Update Date:2021-11-12
Deactivation Date:2021-10-18
Deactivation Code:
Reactivation Date:2021-10-26
Provider Licenses
StateLicense IDTaxonomies
AL1-125961363LF0000X, 363LP0808X
MS902623363LF0000X, 363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental Health
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily