Provider Demographics
NPI:1992118301
Name:MILLER, MELISSA JANE (RN, APRN, AGPCNP-BC)
Entity type:Individual
Prefix:
First Name:MELISSA
Middle Name:JANE
Last Name:MILLER
Suffix:
Gender:F
Credentials:RN, APRN, AGPCNP-BC
Other - Prefix:
Other - First Name:MELISSA
Other - Middle Name:
Other - Last Name:DESO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:4009 WORTH ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75246-1608
Mailing Address - Country:US
Mailing Address - Phone:214-820-9115
Mailing Address - Fax:214-820-9135
Practice Address - Street 1:4009 WORTH ST
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75246-1608
Practice Address - Country:US
Practice Address - Phone:214-820-9115
Practice Address - Fax:214-820-9135
Is Sole Proprietor?:No
Enumeration Date:2014-06-04
Last Update Date:2022-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TXAP125396363L00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse Practitioner
Provider Identifiers
StateIdentifier IDID TypeIssuer
352159YKY6Medicare PIN