Provider Demographics
NPI:1538539374
Name:MILLER, SHEILA DIANE (APRN, FNP-C)
Entity type:Individual
Prefix:
First Name:SHEILA
Middle Name:DIANE
Last Name:MILLER
Suffix:
Gender:F
Credentials:APRN, FNP-C
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1015 S COMMERCE ST
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-5018
Mailing Address - Country:US
Mailing Address - Phone:580-221-5603
Mailing Address - Fax:580-221-5648
Practice Address - Street 1:1015 S COMMERCE ST
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-5018
Practice Address - Country:US
Practice Address - Phone:580-221-5603
Practice Address - Fax:580-221-5648
Is Sole Proprietor?:No
Enumeration Date:2015-10-06
Last Update Date:2023-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKR0086060163WG0600X, 363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
No163WG0600XNursing Service ProvidersRegistered NurseGerontology
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200612420AMedicaid
OK460841ZME3OtherMEDICARE
OKR0086060OtherSTATE LICENSE
OKR0086060OtherSTATE LICENSE
OKR0086060OtherSTATE LICENSE