Provider Demographics
NPI:1902937121
Name:MILLER, MISTY LYNN (BSW, QMRP)
Entity Type:Individual
Prefix:MRS
First Name:MISTY
Middle Name:LYNN
Last Name:MILLER
Suffix:
Gender:F
Credentials:BSW, QMRP
Other - Prefix:MRS
Other - First Name:MISTY
Other - Middle Name:LYNN
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BSW, QMRP
Mailing Address - Street 1:607 N RIDGEVIEW DR
Mailing Address - Street 2:
Mailing Address - City:WARRENSBURG
Mailing Address - State:MO
Mailing Address - Zip Code:64093-9338
Mailing Address - Country:US
Mailing Address - Phone:660-747-7990
Mailing Address - Fax:660-747-7997
Practice Address - Street 1:607 N RIDGEVIEW DR
Practice Address - Street 2:
Practice Address - City:WARRENSBURG
Practice Address - State:MO
Practice Address - Zip Code:64093-9338
Practice Address - Country:US
Practice Address - Phone:660-747-7990
Practice Address - Fax:660-747-7997
Is Sole Proprietor?:No
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator